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Shen Q, Zhao X, Ji Y, Chai P. Deletion of cis-regulatory Element in FOXL2 Promoter in a Chinese Family of Type II Blepharophimosis-ptosis-epicanthus Inversus Syndrome with Polydactyly. J Craniofac Surg 2024; 35:e52-e56. [PMID: 37938073 PMCID: PMC10749674 DOI: 10.1097/scs.0000000000009801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/26/2023] [Indexed: 11/09/2023] Open
Abstract
Blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) is a relatively uncommon autosomal-dominant genetic disorder, primarily attributed to mutations in the forkhead box L2 (FOXL2) gene. Albeit the involvement of protein-coding regions of FOXL2 has been observed in the majority of BPES cases, whether deficiencies in regulatory elements lead to the pathogenesis remains poorly understood. Herein, an autosomal-dominant BPES type II family was included. Peripheral venous blood has been collected, and genomic DNA has been extracted from leukocytes. A whole exome sequencing analysis has been performed and analyzed (Deposited in NODE database: OER422653). The promoter region of FOXL2 was amplified using polymerase chain reaction (PCR). The luciferase reporter assay was performed to identify the activity of this region. In this study, we present a Chinese family diagnosed with type II BPES, characterized by the presence of small palpebral fissures, ptosis, telecanthus, and epicanthus inversus. Notably, all male individuals within the family display polydactyly. A 225-bp deletion in the 556-bp 5'-upstream to transcription start site of FOXL2 , decorated by multiple histone modifications, was identified in affected members of the family. This deletion significantly decreased FOXL2 promoter activity, as measured by the luciferase assay. Conclusively, a novel 255-bp-deletion of the FOXL2 promoter was identified in Chinese families with BPES. Our results expand the spectrum of known FOXL2 mutations and provide additional insight into the genotype-phenotype relationships of the BPES pathogenesis. In addition, this study indicates the important role of genetic screening of cis-regulatory elements in testing heritable diseases.
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Affiliation(s)
- Qin Shen
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, People's Republic of China
| | - Xiaojun Zhao
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, People's Republic of China
| | - Yongrong Ji
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, People's Republic of China
| | - Peiwei Chai
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, People's Republic of China
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Rinaldi B, Villa R, Sironi A, Garavelli L, Finelli P, Bedeschi MF. Smith-Magenis Syndrome—Clinical Review, Biological Background and Related Disorders. Genes (Basel) 2022; 13:genes13020335. [PMID: 35205380 PMCID: PMC8872351 DOI: 10.3390/genes13020335] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/03/2022] [Accepted: 02/08/2022] [Indexed: 02/06/2023] Open
Abstract
Smith-Magenis syndrome (SMS) is a complex genetic disorder characterized by distinctive physical features, developmental delay, cognitive impairment, and a typical behavioral phenotype. SMS is caused by interstitial 17p11.2 deletions (90%), encompassing multiple genes and including the retinoic acid-induced 1 gene (RAI1), or by pathogenic variants in RAI1 itself (10%). RAI1 is a dosage-sensitive gene expressed in many tissues and acting as transcriptional regulator. The majority of individuals exhibit a mild-to-moderate range of intellectual disability. The behavioral phenotype includes significant sleep disturbance, stereotypes, maladaptive and self-injurious behaviors. In this review, we summarize current clinical knowledge and therapeutic approaches. We further discuss the common biological background shared with other conditions commonly retained in differential diagnosis.
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Affiliation(s)
- Berardo Rinaldi
- Clinical Genetics Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (B.R.); (R.V.)
| | - Roberta Villa
- Clinical Genetics Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (B.R.); (R.V.)
| | - Alessandra Sironi
- Experimental Research Laboratory of Medical Cytogenetics and Molecular Genetics, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy; (A.S.); (P.F.)
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Segrate, 20090 Milan, Italy
| | - Livia Garavelli
- Clinical Genetics Unit, Azienda USL-IRCCS of Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Palma Finelli
- Experimental Research Laboratory of Medical Cytogenetics and Molecular Genetics, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy; (A.S.); (P.F.)
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Segrate, 20090 Milan, Italy
| | - Maria Francesca Bedeschi
- Clinical Genetics Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (B.R.); (R.V.)
- Correspondence:
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Rive Le Gouard N, Jacquinet A, Ruaud L, Deleersnyder H, Ageorges F, Gallard J, Lacombe D, Odent S, Mikaty M, Manouvrier-Hanu S, Ghoumid J, Geneviève D, Lehman N, Philip N, Edery P, Héron D, Rastel C, Chancenotte S, Thauvin-Robinet C, Faivre L, Perrin L, Verloes A. Smith-Magenis syndrome: Clinical and behavioral characteristics in a large retrospective cohort. Clin Genet 2021; 99:519-528. [PMID: 33368193 DOI: 10.1111/cge.13906] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/28/2020] [Accepted: 12/22/2020] [Indexed: 11/30/2022]
Abstract
Smith-Magenis syndrome (SMS), characterized by dysmorphic features, neurodevelopmental disorder, and sleep disturbance, is due to an interstitial deletion of chromosome 17p11.2 (90%) or to point mutations in the RAI1 gene. In this retrospective cohort, we studied the clinical, cognitive, and behavioral profile of 47 European patients with SMS caused by a 17p11.2 deletion. We update the clinical and neurobehavioral profile of SMS. Intrauterine growth was normal in most patients. Prenatal anomalies were reported in 15%. 60% of our patients older than 10 years were overweight. Prevalence of heart defects (6.5% tetralogy of Fallot, 6.5% pulmonary stenosis), ophthalmological problems (89%), scoliosis (43%), or deafness (32%) were consistent with previous reports. Epilepsy was uncommon (2%). We identified a high prevalence of obstipation (45%). All patients had learning difficulties and developmental delay, but ID range was wide and 10% of patients had IQ in the normal range. Behavioral problems included temper tantrums and other difficult behaviors (84%) and night-time awakenings (86%). Optimal care of SMS children is multidisciplinary and requires important parental involvement. In our series, half of patients were able to follow adapted schooling, but 70% of parents had to adapt their working time, illustrating the medical, social, educative, and familial impact of having a child with SMS.
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Affiliation(s)
- Nicolas Rive Le Gouard
- Department of Genetics, APHP Nord-Université de Paris Robert Debré University Hospital and INSERM U1141 NeuroDiderot, Paris, France
| | - Adeline Jacquinet
- Department of Genetics, APHP Nord-Université de Paris Robert Debré University Hospital and INSERM U1141 NeuroDiderot, Paris, France.,Department of Genetics, Sart Tilman University Hospital, Liège, Belgium
| | - Lyse Ruaud
- Department of Genetics, APHP Nord-Université de Paris Robert Debré University Hospital and INSERM U1141 NeuroDiderot, Paris, France
| | - Hélène Deleersnyder
- Department of Genetics, APHP Nord-Université de Paris Robert Debré University Hospital and INSERM U1141 NeuroDiderot, Paris, France
| | - Faustine Ageorges
- Department of Genetics, APHP Nord-Université de Paris Robert Debré University Hospital and INSERM U1141 NeuroDiderot, Paris, France
| | - Jennifer Gallard
- Department of Genetics, APHP Nord-Université de Paris Robert Debré University Hospital and INSERM U1141 NeuroDiderot, Paris, France
| | - Didier Lacombe
- Department of Genetics, Bordeaux, Pellegrin University Hospital, Bordeaux, France
| | - Sylvie Odent
- Department of Genetics, Rennes University Hospital, Rennes, France
| | - Myriam Mikaty
- Department of Genetics, Rennes University Hospital, Rennes, France
| | | | - Jamal Ghoumid
- Department of Genetics, Lille Jeanne de Flandre, University Hospital, Lille, France
| | - David Geneviève
- Department of Genetics, Arnaud de Villeneuve University Hospital, Montpellier, France
| | - Natacha Lehman
- Department of Genetics, Arnaud de Villeneuve University Hospital, Montpellier, France
| | - Nicole Philip
- Department of Genetics, la Timone University Hospital, Marseille, France
| | - Patrick Edery
- Department of Genetics, Femme-Mère-Enfant University Hospital, Lyon, France
| | - Delphine Héron
- Department of Genetics, APHP Pitié-Salpêtrière University Hospital, Paris, France
| | - Coralie Rastel
- Department of Genetics, APHP Pitié-Salpêtrière University Hospital, Paris, France
| | | | | | - Laurence Faivre
- Department of Genetics, Dijon University Hospital, Dijon, France
| | - Laurence Perrin
- Department of Genetics, APHP Nord-Université de Paris Robert Debré University Hospital and INSERM U1141 NeuroDiderot, Paris, France
| | - Alain Verloes
- Department of Genetics, APHP Nord-Université de Paris Robert Debré University Hospital and INSERM U1141 NeuroDiderot, Paris, France
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Poisson A, Nicolas A, Cochat P, Sanlaville D, Rigard C, de Leersnyder H, Franco P, Des Portes V, Edery P, Demily C. Behavioral disturbance and treatment strategies in Smith-Magenis syndrome. Orphanet J Rare Dis 2015; 10:111. [PMID: 26336863 PMCID: PMC4559928 DOI: 10.1186/s13023-015-0330-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 08/27/2015] [Indexed: 11/10/2022] Open
Abstract
Background Smith-Magenis syndrome is a complex neurodevelopmental disorder that includes intellectual deficiency, speech delay, behavioral disturbance and typical sleep disorders. Ninety percent of the cases are due to a 17p11.2 deletion encompassing the RAI1 gene; other cases are linked to mutations of the same gene. Behavioral disorders often include outbursts, attention deficit/hyperactivity disorders, self-injury with onychotillomania and polyembolokoilamania (insertion of objects into body orifices), etc. Interestingly, the stronger the speech delay and sleep disorders, the more severe the behavioral issues. Sleep disturbances associate excessive daytime sleepiness with nighttime agitation. They are underpinned by an inversion of the melatonin secretion cycle. However, the combined intake of beta-blockers in the morning and melatonin in the evening may radically alleviate the circadian rhythm problems. Discussion Once sleep disorders are treated, the next challenge is finding an effective treatment for the remaining behavioral problems. Unfortunately, there is a lack of objective guidelines. A comprehensive evaluation of such disorders should include sleep disorders, potential causes of pain, neurocognitive level and environment (i.e. family and school). In any case, efforts should focus on improving communication skills, identifying and treating attention deficit/hyperactivity, aggressiveness and anxiety. Summary Treatment of Smith-Magenis syndrome is complex and requires a multidisciplinary team including, among others, geneticists, psychiatrists, neuropediatricians/neurologists, somnologists, developmental and behavioral pediatricians, and speech and language therapists.
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Affiliation(s)
- Alice Poisson
- Center for Screening and Treatment of Psychiatric Disorders of Genetic Origin, Vinatier Hospital, 95 Bd Pinel, 69678, Lyon, France. .,Cognitive Neuroscience Center, UMR 5229, French National Research Center (CNRS), Bron, France. .,Lyon 1 University, Lyon, France.
| | - Alain Nicolas
- Center for Screening and Treatment of Psychiatric Disorders of Genetic Origin, Vinatier Hospital, 95 Bd Pinel, 69678, Lyon, France.,Michel Jouvet Unite (sleep Medicine), Vinatier Hospital, Human chronobiology team INSERM 846, Bron, France
| | - Pierre Cochat
- Lyon 1 University, Lyon, France.,Pediatric Nephrology and Rhumatology Ward, Reference Center for Rare Kidney Diseases, Civil Hospices of Lyon, INSERM U820, Bron, France
| | - Damien Sanlaville
- Lyon 1 University, Lyon, France.,Department of Genetics, Reference Center for Developmental Anomalies and Malformation Syndromes, Civil Hospices of Lyon, Bron, France
| | - Caroline Rigard
- Center for Screening and Treatment of Psychiatric Disorders of Genetic Origin, Vinatier Hospital, 95 Bd Pinel, 69678, Lyon, France.,Cognitive Neuroscience Center, UMR 5229, French National Research Center (CNRS), Bron, France
| | | | - Patricia Franco
- Lyon 1 University, Lyon, France.,Hypnology Unit, Neuropediatric Ward, Civil Hospices of Lyon and INSERM U628, Lyon, France
| | - Vincent Des Portes
- Lyon 1 University, Lyon, France.,Pediatric Neurology Ward, Reference Center "Intellectual Deficiencies with Rare Causes", Civil Hospices of Lyon, Bron, France. CNRS UMR 5304, L2C2, Institute of Cognitive Sciences, 69675, Bron, France
| | - Patrick Edery
- Lyon 1 University, Lyon, France.,Department of Genetics, Reference Center for Developmental Anomalies and Malformation Syndromes, Civil Hospices of Lyon, Bron, France.,Neuroscience Research Center of Lyon, Inserm U1028, CNRS UMR 5292, UCBL, TIGER Team, Bron, France
| | - Caroline Demily
- Center for Screening and Treatment of Psychiatric Disorders of Genetic Origin, Vinatier Hospital, 95 Bd Pinel, 69678, Lyon, France.,Cognitive Neuroscience Center, UMR 5229, French National Research Center (CNRS), Bron, France.,Lyon 1 University, Lyon, France
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Poisson A, Nicolas A, Sanlaville D, Cochat P, De Leersnyder H, Rigard C, Franco P, des Portes V, Edery P, Demily C. [Smith-Magenis syndrome is an association of behavioral and sleep/wake circadian rhythm disorders]. Arch Pediatr 2015; 22:638-45. [PMID: 25934608 DOI: 10.1016/j.arcped.2015.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 12/21/2014] [Accepted: 03/21/2015] [Indexed: 12/12/2022]
Abstract
Smith-Magenis syndrome (SMS) is a genetic disorder characterized by the association of facial dysmorphism, oral speech delay, as well as behavioral and sleep/wake circadian rhythm disorders. Most SMS cases (90%) are due to a 17p11.2 deletion encompassing the RAI1 gene; other cases stem from mutations of the RAI1 gene. Behavioral issues may include frequent outbursts, attention deficit/hyperactivity disorders, self-injuries with onychotillomania and polyembolokoilamania (insertion of objects into bodily orifices), etc. It is noteworthy that the longer the speech delay and the more severe the sleep disorders, the more severe the behavioral issues are. Typical sleep/wake circadian rhythm disorders associate excessive daytime sleepiness with nocturnal agitation. They are related to an inversion of the physiological melatonin secretion cycle. Yet, with an adapted therapeutic strategy, circadian rhythm disorders can radically improve. Usually an association of beta-blockers in the morning (stops daily melatonin secretion) and melatonin in the evening (mimics the evening deficient peak) is used. Once the sleep disorders are controlled, effective treatment of the remaining psychiatric features is needed. Unfortunately, as for many orphan diseases, objective guidelines have not been drawn up. However, efforts should be focused on improving communication skills. In the same vein, attention deficit/hyperactivity disorders, aggressiveness, and anxiety should be identified and specifically treated. This whole appropriate medical management is underpinned by the diagnosis of SMS. Diagnostic strategies include fluorescent in situ hybridization (FISH) or array comparative genomic hybridization (array CGH) when a microdeletion is sought and Sanger sequencing when a point mutation is suspected. Thus, the diagnosis of SMS can be made from a simple blood sample and should be questioned in subjects of any age presenting with an association of facial dysmorphism, speech delay with behavioral and sleep/wake circadian rhythm disorders, and other anomalies including short stature and mild dysmorphic features.
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Affiliation(s)
- A Poisson
- UDEIP, centre de dépistage et de prise en charge des troubles psychiatriques d'origine génétique, centre hospitalier le Vinatier, 95, boulevard Pinel, 69678 Bron cedex, France; Centre de neurosciences cognitives, UMR 5229 CNRS, 69500 Bron, France; Université Lyon 1, 69500 Lyon, France.
| | - A Nicolas
- UDEIP, centre de dépistage et de prise en charge des troubles psychiatriques d'origine génétique, centre hospitalier le Vinatier, 95, boulevard Pinel, 69678 Bron cedex, France; Université Lyon 1, 69500 Lyon, France
| | - D Sanlaville
- Université Lyon 1, 69500 Lyon, France; Service de génétique, centre des anomalies du développement, laboratoire de cytogénétique, hospices civils de Lyon, 69500 Bron, France
| | - P Cochat
- Université Lyon 1, 69500 Lyon, France; Service de néphrologie et rhumatologie pédiatrique, centre de référence des maladies rénales rares, Inserm U820, hospices civils de Lyon, 69500 Bron, France
| | - H De Leersnyder
- Centre de recherche en neurosciences de Lyon, Inserm U1028, CNRS UMR 5292, UCBL, équipe TIGER, 69500 Bron, France
| | - C Rigard
- UDEIP, centre de dépistage et de prise en charge des troubles psychiatriques d'origine génétique, centre hospitalier le Vinatier, 95, boulevard Pinel, 69678 Bron cedex, France; Centre de neurosciences cognitives, UMR 5229 CNRS, 69500 Bron, France
| | - P Franco
- Université Lyon 1, 69500 Lyon, France; Unité d'hypnologie, service de neuropédiatrie, Inserm U 628, hospices civils de Lyon, 69500 Bron, France
| | - V des Portes
- Université Lyon 1, 69500 Lyon, France; Centre de référence X fragile et autres déficiences intellectuelles de causes rares, hospices civils de Lyon, 69500 Bron, France
| | - P Edery
- Service de génétique, centre de référence des anomalies du développement et des syndromes malformatifs, hospices civils de Lyon, 69500 Bron, France; Université Lyon 1, 69500 Lyon, France; Centre de référence X fragile et autres déficiences intellectuelles de causes rares, hospices civils de Lyon, 69500 Bron, France
| | - C Demily
- UDEIP, centre de dépistage et de prise en charge des troubles psychiatriques d'origine génétique, centre hospitalier le Vinatier, 95, boulevard Pinel, 69678 Bron cedex, France; Centre de neurosciences cognitives, UMR 5229 CNRS, 69500 Bron, France; Université Lyon 1, 69500 Lyon, France
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Abstract
Smith-Magenis syndrome (SMS) is a complex neurobehavioral disorder caused by haploinsufficiency of the retinoic acid-induced 1 (RAI1) gene on chromosome 17p11.2. Diagnostic strategies include molecular identification of a 17p11.2 microdeletion encompassing RAI1 or a mutation in RAI1. G-banding and fluorescent in situ hybridization (FISH) are the classical methods used to detect the SMS deletions, while multiplex ligation-dependent probe amplification (MLPA) and real-time quantitative PCR are the newer, cost-effective, and high-throughput technologies. Most SMS features are due to RAI1 haploinsufficiency, while the variability and severity of the disorder are modified by other genes in the 17p11.2 region. The functional role for RAI1 is not completely understood, but it is likely involved in transcription, based on homology and preliminary studies. Management of SMS is primarily a multidisciplinary approach and involves treatment for sleep disturbance, speech and occupational therapies, minor medical interventions, and management of behaviors.
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Edelman EA, Girirajan S, Finucane B, Patel PI, Lupski JR, Smith ACM, Elsea SH. Gender, genotype, and phenotype differences in Smith-Magenis syndrome: a meta-analysis of 105 cases. Clin Genet 2007; 71:540-50. [PMID: 17539903 DOI: 10.1111/j.1399-0004.2007.00815.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Smith-Magenis syndrome (SMS) is a multisystem disorder characterized by developmental delay and mental retardation, a distinctive behavioral phenotype, and sleep disturbance. We undertook a comprehensive meta-analysis to identify genotype-phenotype relationships to further understand the clinical variability and genetic factors involved in SMS. Clinical and molecular information on 105 patients with SMS was obtained through research protocols and a review of the literature and analyzed using Fisher's exact test with two-tailed p values. Several differences in these groups of patients were identified based on genotype and gender. Patients with RAI1 mutation were more likely to exhibit overeating, obesity, polyembolokoilamania, self-hugging, muscle cramping, and dry skin and less likely to have short stature, hearing loss, frequent ear infections, and heart defects when compared with patients with deletion, while a subset of small deletion cases with deletions spanning from TNFRSF13B to MFAP4 was less likely to exhibit brachycephaly, dental anomalies, iris abnormalities, head-banging, and hyperactivity. Significant differences between genders were also identified, with females more likely to have myopia, eating/appetite problems, cold hands and feet, and frustration with communication when compared with males. These results confirm previous findings and identify new genotype-phenotype associations including differences in the frequency of short stature, hearing loss, ear infections, obesity, overeating, heart defects, self-injury, self-hugging, dry skin, seizures, and hyperactivity among others based on genotype. Additional studies are required to further explore the relationships between genotype and phenotype and any potential discrepancies in health care and parental attitudes toward males and females with SMS.
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Affiliation(s)
- E A Edelman
- Department of Human Genetics, Virginia Commonwealth University, Richmond, VA 23298, USA
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