1
|
Alpaslan M, Mestré-Godin S, Lay A, Giacalone G, Helaers R, Adham S, Kovacsik H, Guillemard S, Mercier E, Boon L, Revencu N, Brouillard P, Quere I, Vikkula M. Ureteropelvic junction obstruction with primary lymphoedema associated with CELSR1 variants. J Med Genet 2023; 60:1161-1168. [PMID: 37225411 DOI: 10.1136/jmg-2023-109171] [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: 01/19/2023] [Accepted: 05/07/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Primary lymphoedema (PL) is a chronic, debilitating disease caused by developmental and functional defects of the lymphatic system. It is marked by an accumulation of interstitial fluid, fat and tissue fibrosis. There is no cure. More than 50 genes and genetic loci have been linked to PL. We sought to study systematically cell polarity signalling protein Cadherin Epidermal Growth Factor Laminin G Seven-pass G-type Receptor 1 (CELSR1) variants linked to PL. METHODS We investigated 742 index patients from our PL cohort using exome sequencing. RESULTS We identified nine variants predicted to cause CELSR1 loss of function. Four of them were tested for nonsense-mediated mRNA decay, but none was observed. Most of the truncated CELSR1 proteins would lack the transmembrane domain, if produced. The affected individuals had puberty/late-onset PL on lower extremities. The variants had a statistically significant difference in penetrance between female patients (87%) and male patients (20%). Eight variant carriers had a kidney anomaly, mostly in the form of ureteropelvic junction obstruction, which has not been associated with CELSR1 before. CELSR1 is located in the 22q13.3 deletion locus of the Phelan-McDermid syndrome. As variable renal defects are often seen in patients with the Phelan-McDermid syndrome, CELSR1 may be the long-sought gene for the renal defects. CONCLUSION PL associated with a renal anomaly suggests a CELSR1-related cause.
Collapse
Affiliation(s)
- Murat Alpaslan
- Human Molecular Genetics, de Duve Institute, Brussels, Belgium
| | - Sandrine Mestré-Godin
- Department of vascular medicine, CHU Montpellier, Montpellier, France
- IDESP - Institut Desbrest d'Épidémiologie et de Santé Publique, Montpellier, France
| | - Aurélie Lay
- Department of vascular medicine, CHU Montpellier, Montpellier, France
| | - Guido Giacalone
- Department of Lymphatic Surgery, VASCERN PPL European Reference Centre, General Hospital Sint-Maarten, Mechelen, Belgium
| | - Raphaël Helaers
- Human Molecular Genetics, de Duve Institute, Brussels, Belgium
| | - Salma Adham
- Department of vascular medicine, CHU Montpellier, Montpellier, France
- IDESP - Institut Desbrest d'Épidémiologie et de Santé Publique, Montpellier, France
| | - Hélène Kovacsik
- Department of vascular medicine, CHU Montpellier, Montpellier, France
| | - Sophie Guillemard
- Department of Nuclear Medicine, Montpellier Regional Cancer Institute, Montpellier, France
| | - Erick Mercier
- IDESP - Institut Desbrest d'Épidémiologie et de Santé Publique, Montpellier, France
- Hematology Laboratory, University Hospital Centre Nimes, Nimes, France
| | - Laurence Boon
- Human Molecular Genetics, de Duve Institute, Brussels, Belgium
- Center for Vascular Anomalies, Division of Plastic Surgery, VASCERN VASCA European Reference Centre, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Nicole Revencu
- Center for Vascular Anomalies, Division of Plastic Surgery, VASCERN VASCA European Reference Centre, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | | | - Isabelle Quere
- Department of vascular medicine, CHU Montpellier, Montpellier, France
- IDESP - Institut Desbrest d'Épidémiologie et de Santé Publique, Montpellier, France
| | - Miikka Vikkula
- Human Molecular Genetics, de Duve Institute, Brussels, Belgium
- WELBIO, WEL Research Institute, Wavre, Belgium
| |
Collapse
|
2
|
Smith MS, Sarasua SM, Rogers C, Phelan K, Boccuto L. Lymphedema is associated with CELSR1 in Phelan-McDermid syndrome. Clin Genet 2023; 104:472-478. [PMID: 37232218 DOI: 10.1111/cge.14364] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/27/2023]
Abstract
Lymphedema is a troubling condition present in many disorders including the rare genetic disorder known as Phelan-McDermid syndrome (PMS). The neurobehavioral features of PMS, also known as 22q13.3 deletion syndrome, have been investigated, but little research exists on lymphedema in PMS. In this investigation, clinical and genetic data from 404 people with PMS were reviewed from the PMS-International Registry revealing a prevalence of 5% with lymphedema. Lymphedema was reported in 1 out of 47 people (2.1%) with PMS due to a SHANK3 variant and 19 out of 357 people (5.3%) with PMS due to 22q13.3 deletions. Lymphedema was more common among those in their teens or adulthood (p = 0.0011) and those with deletions >4 Mb. People with lymphedema had significantly larger deletions (mean 5.375 Mb) than those without lymphedema (mean 3.464 Mb, p = 0.00496). Association analysis identified a deletion of the CELSR1 gene to be the biggest risk factor (OR = 12.9 95% CI [2.9-56.2]). Detailed assessment of 5 subjects identified all had deletions of CELSR1, developed symptoms of lymphedema starting at age 8 or older, and typically responded well to standard therapy. In conclusion, this is the largest assessment of lymphedema in PMS to date and our results suggest that individuals with deletions >4 Mb or those with CELSR1 deletions should be assessed for lymphedema.
Collapse
Affiliation(s)
- Marie S Smith
- School of Nursing, Healthcare Genetics Program, Clemson University, Clemson, South Carolina, USA
| | - Sara M Sarasua
- School of Nursing, Healthcare Genetics Program, Clemson University, Clemson, South Carolina, USA
| | - Curtis Rogers
- Greenwood Genetic Center, Greenwood, South Carolina, USA
| | - Katy Phelan
- Genetics Laboratory, Florida Cancer Specialists & Research Institute, Fort Myers, Florida, USA
| | - Luigi Boccuto
- School of Nursing, Healthcare Genetics Program, Clemson University, Clemson, South Carolina, USA
| |
Collapse
|
3
|
Damstra RJ, Vignes S, Mansour S. Consensus recommendations on lymphedema in Phelan-McDermid syndrome. Eur J Med Genet 2023; 66:104767. [PMID: 37075886 DOI: 10.1016/j.ejmg.2023.104767] [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: 12/05/2022] [Revised: 04/03/2023] [Accepted: 04/12/2023] [Indexed: 04/21/2023]
Abstract
Phelan-McDermid syndrome (PMS) is a neurodevelopmental disorder caused by deletions 22q13.3 or pathogenic variants in the SHANK3 gene. Lymphedema can be a clinical feature in 10-25% of individuals with PMS due to a deletion 22q13.3, but is not observed in those with a SHANK3 variant. This paper forms a part of the European consensus guideline for PMS and focuses on what is known regarding lymphedema in PMS in order to present clinical recommendations. The mechanism causing lymphedema in PMS is unknown. Lymphedema can be suggested by pitting oedema of the extremities or, in later stages, non-pitting swelling. It can occur already at a young age and be progressive if untreated, impacting daily functioning. Lymphedema can be treated using existing general multidisciplinary management guidelines, taking the functioning of the individual with PMS into account. Furthermore, well-known risk factors for the development of lymphedema as lack of physical activities and weight gain/obesity should be addressed. Diagnosis and treatment are best performed in a multidisciplinary centre of expertise.
Collapse
Affiliation(s)
- Robert J Damstra
- VASCERN PPL European Reference Centre: Expert Center for Lymphovascular Medicine, Nij Smellinghe Hospital, Drachten, the Netherlands.
| | - Stéphane Vignes
- VASCERN PPL European Reference Centre: French Reference Center Rare Vascular Diseases, Department of Lymphology, AP-HP, HEGP Hôpital Européen Georges Pompidou, Paris, France
| | - Sahar Mansour
- SW Thames Centre for Genomics, St George's University Hospitals NHS Foundation Trust, UK and St George's University of London, London, UK
| |
Collapse
|
4
|
Seo SH, Lee S, Park JKH, Yang EJ, Kim B, Lee JS, Kim MJ, Park SS, Seong MW, Nam SY, Heo CY, Myung Y. Clinical staging and genetic profiling of Korean patients with primary lymphedema using targeted gene sequencing. Sci Rep 2022; 12:13591. [PMID: 35948757 PMCID: PMC9365773 DOI: 10.1038/s41598-022-17958-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 08/03/2022] [Indexed: 11/23/2022] Open
Abstract
Lymphedema is a progressive disease caused by lymphatic flow blockage in the lymphatic pathway. Primary (hereditary) lymphedema is caused by genetic mutations without secondary causes. We performed clinical profiling on Korean primary lymphedema patients based on their phenotypes using lymphoscintigraphy and made genetic diagnoses using a next-generation sequencing panel consisting of 60 genes known to be related to primary lymphedema and vascular anomalies. Of 27 patients included in this study, 14.8% of the patients had lymphedema of the upper extremities, 77.8% had lymphedema of the lower extremities and 7.4% had 4-limbs lymphedema. Based on the International Society of Lymphology staging, 14, 10, and 3 patients had stage 3, 2, and 1 lymphedema, respectively. Only one family was genetically confirmed to harbor likely pathogenic variants in CELSR1. The proband was carrying two likely pathogenic variants in CELSR1, while her symptomatic mother was confirmed to carry only one of the variants. Furthermore, two other variants of uncertain significance in CELSR1 were detected in other patients, making CELSR1 the most commonly altered gene in our study. The clinical and genetic profile of hereditary lymphedema reported here is the first such data series reported for South Korea.
Collapse
Affiliation(s)
- Soo Hyun Seo
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Seungjun Lee
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Joseph Kyu-Hyung Park
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Eun Joo Yang
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Boram Kim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jee-Soo Lee
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Man Jin Kim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Sung Sup Park
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Moon-Woo Seong
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Sun-Young Nam
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Chan-Yeong Heo
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Yujin Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea.
| |
Collapse
|
5
|
Colmant C, Turpin S, Lambert R, Wong N, Ondrejchak S, Lapointe C, Powell J, Dubois J, McCuaig C. Pediatric Lymphedema: Study of 180 Patients Referred to a Tertiary Lymphedema Clinic. J Cutan Med Surg 2022; 26:502-511. [PMID: 35848765 DOI: 10.1177/12034754221112002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Lymphedema is due to dysfunction of the lymphatic system. It can be primary or secondary. Pediatric lymphedema is more often primary and is a chronic disease with a heavy burden on quality of life. METHODS Medical records of patients under 18 years of age referred between 1996 and 2021 to the specialized lymphedema clinic at the Sainte-Justine University Hospital Center were reviewed. Demographic data, sex, age at presentation, location of the lymphedema, clinical features, genetic testing, symptoms, complications, investigations, and treatment were collected. RESULTS Of 180 referred patients, lymphedema was confirmed in 151, and 137 were primary lymphedema. Median age of apparition of primary lymphedema was 7.00 years and was significantly lower in boys than in girls. Primary congenital lymphedema was more frequent in boys (51.0%, 27.3% in girls, P = .007), and onset of primary lymphedema during adolescence was more frequent in girls (53.4%, 25.0% in boys, P = .001). Lower limbs were the most impacted (88.3%). Sixty patients had genetic testing, and 38 (63.3%) of them were discovered to have a pertinent genetic mutation. The most common mutated gene was the FLT4 gene (in 9 patients). Seven patients (5.1%) had associated extensive/central lymphatic malformation and 24 (17.6%) had a polymalformative syndrome/syndromic lymphedema. CONCLUSIONS Pediatric lymphedema is more frequent in girls, usually involves lower limb, and is most often sporadic, but often associated with a genetic mutation, and genetic testing should be performed.
Collapse
Affiliation(s)
- Caroline Colmant
- 25461 Dermatology Division, Department of Pediatrics, Sainte-Justine University Hospital Center University of Montreal, Montreal, Quebec, Canada
| | - Sophie Turpin
- 25461 Nuclear Medicine Division, Department of Medical Imaging, Sainte-Justine University Hospital Center University of Montreal, Montreal, Quebec, Canada
| | - Raymond Lambert
- 25461 Nuclear Medicine Division, Department of Medical Imaging, Sainte-Justine University Hospital Center University of Montreal, Montreal, Quebec, Canada
| | - Nicole Wong
- 25461 Dermatology Division, Department of Pediatrics, Sainte-Justine University Hospital Center University of Montreal, Montreal, Quebec, Canada
| | - Sandra Ondrejchak
- 25461 Vascular Anomalies Nurse, Sainte-Justine University Hospital Center University of Montreal, Montreal, Quebec, Canada
| | - Chantal Lapointe
- 25461 Physiotherapy, Sainte-Justine University Hospital Center University of Montreal, Montreal, Quebec, Canada
| | - Julie Powell
- 25461 Dermatology Division, Department of Pediatrics, Sainte-Justine University Hospital Center University of Montreal, Montreal, Quebec, Canada
| | - Josée Dubois
- 25461 Department of Medical Imaging, Sainte-Justine University Hospital Center University of Montreal, Montreal, Quebec, Canada
| | - Catherine McCuaig
- 25461 Dermatology Division, Department of Pediatrics, Sainte-Justine University Hospital Center University of Montreal, Montreal, Quebec, Canada
| |
Collapse
|
6
|
|