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Castilho NL, Resende KKM, dos Santos JA, Machado RA, Coletta RD, Guerra ENS, Acevedo AC, Martelli-Junior H. Oligodontia in the Clinical Spectrum of Syndromes: A Systematic Review. Dent J (Basel) 2023; 11:279. [PMID: 38132417 PMCID: PMC10742796 DOI: 10.3390/dj11120279] [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: 08/29/2023] [Revised: 11/11/2023] [Accepted: 11/17/2023] [Indexed: 12/23/2023] Open
Abstract
The aim of this systematic review was to describe the clinical and genetic features of syndromes showing oligodontia as a sign. The review was performed according to the PRISMA 2020 checklist guidelines, and the search was conducted using PubMed, Scopus, Lilacs, Web of science, Livivo, and EMBASE and supplemented by a gray literature search on Google Scholar and ProQuest, applying key terms relevant to the research questions. The systematic review identified 47 types of syndromes in 83 studies, and the most common was hypohidrotic ectodermal dysplasia, which was reported in 24 patients in 22 studies. Other common syndromes that reported oligodontia included Axenfeld-Rieger syndrome, Witkop's syndrome, Ellis-van Creveld syndrome, blepharocheilodontic syndrome, and oculofaciocardiodental syndrome. The X-linked mode of inheritance was the most reported (n = 13 studies), followed by the autosomal dominant (n = 13 studies). The review describes the main syndromes that may have oligodontia as a clinical sign and reinforces the need for orodental-facial examining for adequate diagnosis and treatment of the affected patients. Molecular analysis in order to better understand the occurrence of oligodontia is imperative.
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Affiliation(s)
- Natália Lopes Castilho
- Health Science Postgraduate Program, State University of Montes Claros, Montes Claros 39400-000, Brazil;
| | - Kêmelly Karolliny Moreira Resende
- Laboratory of Oral Histopathology, Oral Care Center for Inherited Diseases, Health Sciences Faculty, University of Brasilia, Brasilia 70040-010, Brazil; (K.K.M.R.); (E.N.S.G.); (A.C.A.)
| | - Juliana Amorim dos Santos
- Laboratory of Oral Histopathology, Health Sciences Faculty, University of Brasilia, Brasilia 70040-010, Brazil;
| | - Renato Assis Machado
- Department of Oral Diagnosis and Graduate Program in Oral Biology, School of Dentistry, University of Campinas, Piracicaba 13414-018, Brazil; (R.A.M.); (R.D.C.)
| | - Ricardo D. Coletta
- Department of Oral Diagnosis and Graduate Program in Oral Biology, School of Dentistry, University of Campinas, Piracicaba 13414-018, Brazil; (R.A.M.); (R.D.C.)
| | - Eliete Neves Silva Guerra
- Laboratory of Oral Histopathology, Oral Care Center for Inherited Diseases, Health Sciences Faculty, University of Brasilia, Brasilia 70040-010, Brazil; (K.K.M.R.); (E.N.S.G.); (A.C.A.)
| | - Ana Carolina Acevedo
- Laboratory of Oral Histopathology, Oral Care Center for Inherited Diseases, Health Sciences Faculty, University of Brasilia, Brasilia 70040-010, Brazil; (K.K.M.R.); (E.N.S.G.); (A.C.A.)
| | - Hercílio Martelli-Junior
- Health Science Postgraduate Program, State University of Montes Claros, Montes Claros 39400-000, Brazil;
- Oral Medicine and Oral Pathology, School of Dentistry, State University of Montes Claros, Unimontes, Montes Claros 39400-000, Brazil
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Yang Y, Zhu J, Chiba Y, Fukumoto S, Qin M, Wang X. Enamel defects of Axenfeld-Rieger syndrome and the role of PITX2 in its pathogenesis. Oral Dis 2023; 29:3654-3664. [PMID: 35836351 DOI: 10.1111/odi.14315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 06/09/2022] [Accepted: 07/06/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the detailed ultrastructural patterns of dental abnormalities affected by Axenfeld-Rieger syndrome (ARS) with a heterozygous microdeletion involving paired-like homeodomain 2 (PITX2) and explored the underlying molecular mechanisms driving enamel defects. SUBJECTS AND METHODS Sanger sequencing, genomic quantitative PCR analysis, and chromosomal microarray analysis (CMA) were used to screen the disease-causing mutation in one ARS proband. An exfoliated tooth from an ARS patient was analyzed with scanning electron microscopy and micro-computerized tomography. A stable Pitx2 knockdown cell line was generated to simulate PITX2 haploinsufficiency. Cell proliferation and ameloblast differentiation were analyzed, and the role of the Wnt/β-catenin pathway in proliferation of ameloblast precursor cells was investigated. RESULTS An approximately 0.216 Mb novel deletion encompassing PITX2 was identified. The affected tooth displayed a thinner and broken layer of enamel and abnormal enamel biomineralization. PITX2 downregulation inhibited the proliferation and differentiation of inner enamel epithelial cells, and LiCl stifmulation partially reversed the proliferation ability after Pitx2 knockdown. CONCLUSIONS Enamel formation is disturbed in some patients with ARS. Pitx2 knockdown can influence the proliferation and ameloblast differentiation of inner enamel epithelial cells, and PITX2 may regulate cell proliferation via Wnt/β-catenin signaling pathway.
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Affiliation(s)
- Yi Yang
- Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Junxia Zhu
- Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yuta Chiba
- Division of Oral Health, Section of Oral Medicine for Children, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Satoshi Fukumoto
- Division of Oral Health, Section of Oral Medicine for Children, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
- Division of Pediatric Dentistry, Department of Oral Health and Development Sciences, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Man Qin
- Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xin Wang
- Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
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Feng J, Wang Y, Cheng S, Liu Z, Lan L, Miao Q, Zhang C. Case report: Congenital mitral and tricuspid valve insufficiency in a patient with Axenfeld-Rieger syndrome. Front Cardiovasc Med 2022; 9:977432. [PMID: 36211572 PMCID: PMC9537679 DOI: 10.3389/fcvm.2022.977432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Axenfeld-Rieger syndrome (ARS) is an autosomal dominant disorder that is primarily due to disruption of the development of neural crest cells. The onset of associated symptoms in both eyes accompanied by extraocular developmental defects is referred to as ARS. Cardiac defects associated with ARS have been reported, but the extent of the cardiac defects has yet to be defined. We report a case of a 17-year-old girl with ARS with typical facial malformations and severe mitral and tricuspid valve insufficiency. The patient was diagnosed with secondary glaucoma detected on ophthalmologic examination. Echocardiography showed severe mitral and tricuspid valve insufficiency. This case provides further evidence of the association of ARS with cardiac malformations and extends the reported range of cardiac malformations in patients with ARS.
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Affiliation(s)
- Jingwei Feng
- Department of Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yingjiao Wang
- Department of Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Shiyu Cheng
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zishuo Liu
- Department of Ultrasound, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Ling Lan
- Department of Anesthesiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Qi Miao
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Chaoji Zhang
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Chaoji Zhang
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4
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Dental and Maxillofacial Manifestations of Axenfeld–Rieger Syndrome: Presentation of a Case in a 5-Year-Old Girl. Case Rep Dent 2022; 2022:4348264. [PMID: 35957627 PMCID: PMC9363210 DOI: 10.1155/2022/4348264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 06/22/2022] [Accepted: 07/12/2022] [Indexed: 11/18/2022] Open
Abstract
In this case study, the dental and maxillofacial manifestations of a 5-year-old girl with Axenfeld–Rieger syndrome (ARS) are described. This syndrome is characterized by craniomaxillofacial, ocular, dental, and umbilical disorders. The patient presented ocular dyscoria and corectopia, iris abnormalities, midface hypoplasia with a thin upper lip, and a protruded lower lip. Hyperplastic maxillary labial frenulum, oligodontia, ghost teeth, bilateral Class III molar and canine relationship, and right posterior crossbite were also found. An everted umbilicus with redundant periumbilical skin was evident. Early diagnosis of ARS is essential to establishing preventive and corrective measures that provide a good quality of life for patients who suffer from this syndrome.
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Prem Senthil M, Knight LSW, Taranath D, Mackey DA, Ruddle JB, Chiang MY, Siggs OM, Souzeau E, Craig JE. Comparison of Anterior Segment Abnormalities in Individuals With FOXC1 and PITX2 Variants. Cornea 2022; 41:1009-1015. [PMID: 35354164 PMCID: PMC9390227 DOI: 10.1097/ico.0000000000003020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 01/14/2022] [Accepted: 01/31/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Axenfeld-Rieger syndrome encompasses a group of developmental disorders affecting the anterior chamber structures of the eye, with associated systemic features in some cases. This study aims to compare the difference in anterior segment phenotypes such as those involving the cornea, iris, lens, and anterior chamber angle between cases with disease-causing sequence variations in FOXC1 and PITX2 . METHODS This cross-sectional study involved 61 individuals, from 32 families with pathogenic FOXC1 or PITX2 variants, who were registered with the Australian and New Zealand Registry of Advanced Glaucoma. RESULTS The median age of the cohort was 39 years at the time of last assessment (range 3-85 years; females, 54%). Thirty-two patients had pathogenic variants in the FOXC1 gene, and 29 patients had pathogenic variants in the PITX2 gene. Corneal abnormalities were more common in individuals with FOXC1 variants (18/36, 50%) than those with PITX2 variants (4/25, 16%; P = 0.007). Iris abnormalities such as hypoplasia ( P = 0.008) and pseudopolycoria ( P = 0.001) were more common in individuals with PITX2 variants than those with FOXC1 variants. Glaucoma was present in 72% of participants. Corneal decompensation was positively associated with corneal abnormalities ( P < 0.001), glaucoma surgery ( P = 0.025), and cataract surgery ( P = 0.002). CONCLUSIONS Corneal abnormalities were more common in individuals with FOXC1 than in those with PITX2 variants and were often associated with early onset glaucoma. These findings highlight that patients with FOXC1 variations require close follow-up and monitoring throughout infancy and into adulthood.
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Affiliation(s)
- Mallika Prem Senthil
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Lachlan S. W. Knight
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Deepa Taranath
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - David A. Mackey
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Centre for Ophthalmology and Visual Science and Lions Eye Institute, University of Western Australia, Perth, Australia
| | - Jonathan B. Ruddle
- Department of Ophthalmology, Royal Children's Hospital, Melbourne, Australia
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
- Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Mark Y. Chiang
- Queensland Children's Hospital, South Brisbane, Queensland, Australia; and
- University of Queensland, Brisbane, Queensland, Australia
| | - Owen M. Siggs
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Emmanuelle Souzeau
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Jamie E. Craig
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia
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Cazzolla AP, Testa NF, Spirito F, Di Cosola M, Campobasso A, Crincoli V, Ballini A, Cantore S, Ciavarella D, Lo Muzio L, Dioguardi M. Axenfeld-Rieger syndrome: orthopedic and orthodontic management in a pediatric patient: a case report. Head Face Med 2022; 18:25. [PMID: 35804381 PMCID: PMC9264492 DOI: 10.1186/s13005-022-00329-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 06/30/2022] [Indexed: 11/30/2022] Open
Abstract
Axenfeld–Rieger Syndrome (ARS) is a rare autosomal dominant genetic disease with considerable expressive variability, characterized by ocular and non-ocular manifestations, cardiovascular, mild craniofacial abnormalities and dental malformations. Current data report an incidence of Xenfeld-Rieger syndrome in the population of 1: 200,000. The case described is that of a 14-year-old female patient whose ARS is suspected and investigated following a dental specialist visit for orthodontic reasons, acquired the patient’s family and clinical data following a medical approach multidisciplinary, we proceed to the orthodontic involved the use of the Rapid Palatal Expander (RPE) and a fixed orthodontic treatment. The aim of this study is to report the case of the orthopaedic and orthodontic treatment in a patient affected by ARS and with facial dysmorphism and teeth anomalies associated to ocular anomalies.
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Affiliation(s)
- Angela Pia Cazzolla
- Department of Clinical and Experimental Medicine, Università degli Studi di Foggia, Via Luigi Rovelli, 50, 71100, Foggia, Italy
| | - Nunzio Francesco Testa
- Department of Clinical and Experimental Medicine, Università degli Studi di Foggia, Via Luigi Rovelli, 50, 71100, Foggia, Italy
| | - Francesca Spirito
- Department of Clinical and Experimental Medicine, Università degli Studi di Foggia, Via Luigi Rovelli, 50, 71100, Foggia, Italy
| | - Michele Di Cosola
- Department of Clinical and Experimental Medicine, Università degli Studi di Foggia, Via Luigi Rovelli, 50, 71100, Foggia, Italy
| | - Alessandra Campobasso
- Department of Clinical and Experimental Medicine, Università degli Studi di Foggia, Via Luigi Rovelli, 50, 71100, Foggia, Italy
| | - Vito Crincoli
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, "Aldo Moro" University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Andrea Ballini
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, "Aldo Moro" University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy.,Department of Precision Medicine, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | - Stefania Cantore
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, "Aldo Moro" University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy.,Faculty of Dentistry (Fakulteti i Mjekësisë Dentare-FMD), University of Medicine, 1001, Tirana, Albania
| | - Domenico Ciavarella
- Department of Clinical and Experimental Medicine, Università degli Studi di Foggia, Via Luigi Rovelli, 50, 71100, Foggia, Italy
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, Università degli Studi di Foggia, Via Luigi Rovelli, 50, 71100, Foggia, Italy
| | - Mario Dioguardi
- Department of Clinical and Experimental Medicine, Università degli Studi di Foggia, Via Luigi Rovelli, 50, 71100, Foggia, Italy.
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7
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Badnaware S, Srivastava VK, Chandel M, Gupta P, Fulzele P. Dental and Craniofacial Manifestation of Axenfeld-Rieger Syndrome: A Case Report. Cureus 2022; 14:e26442. [PMID: 35923678 PMCID: PMC9339346 DOI: 10.7759/cureus.26442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 06/29/2022] [Indexed: 11/09/2022] Open
Abstract
Axenfeld-Rieger syndrome (ARS) is an autosomal dominant syndrome with a prevalence estimated at 1:50000 to 1:100000 in newborns. It is mainly characterized by ocular, craniofacial, and dental abnormalities. From the pediatric dentist's point of view, early diagnosis of the syndrome from the ocular, craniofacial, and dental manifestation can prevent further abnormalities and ocular complications such as glaucoma. This case report presents a brief description of ARS with the characteristics of craniofacial and dental findings.
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8
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Wang R, Wang WQ, Li XQ, Zhao J, Yang K, Feng Y, Guo MM, Liu M, Liu X, Wang X, Yuan YY, Gao X, Xu JC. A novel variant in FOXC1 associated with atypical Axenfeld-Rieger syndrome. BMC Med Genomics 2021; 14:277. [PMID: 34809627 PMCID: PMC8609746 DOI: 10.1186/s12920-021-01130-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/11/2021] [Indexed: 11/10/2022] Open
Abstract
Mutations in the Forkhead Box C1 (FOXC1) are known to cause autosomal dominant hereditary Axenfeld-Rieger syndrome, which is a genetic disorder characterized by ocular and systemic features including glaucoma, variable dental defects, craniofacial dysmorphism and hearing loss. Due to late-onset of ocular disorders and lack of typical presentation, clinical diagnosis presents a huge challenge. In this study, we described a pathogenic in-frame variant in FOXC1 in one 5-year-old boy who is presented with hypertelorism, pupil deformation in both eyes, conductive hearing loss, and dental defects. By whole exome sequencing, we identified a 3 bp deletion in FOXC1, c.516_518delGCG (p.Arg173del) as the disease-causing variant, which was de novo and not detected in the parents, and could be classified as a "pathogenic variant" according to the American College of Medical Genetics and Genomics guidelines. After confirmation of this FOXC1 variant, clinical data on Axenfeld-Rieger syndrome-associated clinical features were collected and analyzed. Furthermore, Although the affected individual present hearing loss, however, the hearing loss is conductive and is reversible during the follow-up, which might not linke to the FOXC1 variant and is coincidental. Routine examination of FOXC1 is necessary for the genetic diagnosis of hypertelorism-associated syndrome. These findings may assist clinicians in reaching correct clinical and molecular diagnoses, and providing appropriate genetic counseling.
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Affiliation(s)
- Rui Wang
- Postgraduate Training Base Of Jinzhou Medical University (The PLA Rocket Force Characteristic Medical Center), 16# XinWai Da Jie, Beijing, 100088, People's Republic of China
| | - Wei-Qian Wang
- Department of Otolaryngology, The PLA Rocket Force Characteristic Medical Center, 16# XinWai Da Jie, Beijing, 100088, People's Republic of China.,College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, People's Republic of China.,National Clinical Research Center for Otolaryngologic Diseases, State Key Lab of Hearing Science, Ministry of Education, China, Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, People's Republic of China
| | - Xiao-Qin Li
- Department of Ophthalmology, The PLA Rocket Force Characteristic Medical Center, 16# XinWai Da Jie, Beijing, 100088, People's Republic of China
| | - Juan Zhao
- Department of Otolaryngology, The PLA Rocket Force Characteristic Medical Center, 16# XinWai Da Jie, Beijing, 100088, People's Republic of China
| | - Kun Yang
- Department of Otolaryngology, The PLA Rocket Force Characteristic Medical Center, 16# XinWai Da Jie, Beijing, 100088, People's Republic of China
| | - Yong Feng
- Department of Otolaryngology, The PLA Rocket Force Characteristic Medical Center, 16# XinWai Da Jie, Beijing, 100088, People's Republic of China
| | - Meng-Meng Guo
- Department of Otolaryngology, The PLA Rocket Force Characteristic Medical Center, 16# XinWai Da Jie, Beijing, 100088, People's Republic of China
| | - Min Liu
- Department of Otolaryngology, The PLA Rocket Force Characteristic Medical Center, 16# XinWai Da Jie, Beijing, 100088, People's Republic of China
| | - Xing Liu
- Department of Otolaryngology, The PLA Rocket Force Characteristic Medical Center, 16# XinWai Da Jie, Beijing, 100088, People's Republic of China
| | - Xi Wang
- Department of Otolaryngology, The PLA Rocket Force Characteristic Medical Center, 16# XinWai Da Jie, Beijing, 100088, People's Republic of China.
| | - Yong-Yi Yuan
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, People's Republic of China. .,National Clinical Research Center for Otolaryngologic Diseases, State Key Lab of Hearing Science, Ministry of Education, China, Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, People's Republic of China.
| | - Xue Gao
- Department of Otolaryngology, The PLA Rocket Force Characteristic Medical Center, 16# XinWai Da Jie, Beijing, 100088, People's Republic of China.
| | - Jin-Cao Xu
- Department of Otolaryngology, The PLA Rocket Force Characteristic Medical Center, 16# XinWai Da Jie, Beijing, 100088, People's Republic of China.
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Fan Z, Sun S, Liu H, Yu M, Liu Z, Wong SW, Liu Y, Han D, Feng H. Novel PITX2 mutations identified in Axenfeld-Rieger syndrome and the pattern of PITX2-related tooth agenesis. Oral Dis 2019; 25:2010-2019. [PMID: 31529555 DOI: 10.1111/odi.13196] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/25/2019] [Accepted: 09/07/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To investigate the mutations in patients with Axenfeld-Rieger syndrome (ARS) and the pattern of PITX2-related tooth agenesis. METHODS Whole-exome sequencing (WES) and copy number variation (CNV) array were used to screen the mutations in four ARS probands. After Sanger sequencing and quantitative polymerase chain reaction (qPCR) validation, secondary structure prediction and dual-luciferase assay were employed to investigate the functional impact. Eighteen PITX2-mutated patients with definite dental records were retrieved from our database and literatures, and the pattern of PITX2-related tooth agenesis was analyzed. RESULTS A novel de novo segmental deletion of chromosome 4q25 (GRCh37/hg19 chr4:111, 320, 052-111, 754, 236) encompassing PITX2 and three novel PITX2 mutations c.148C > T, c.257G > A, and c.630insCG were identified. Preliminary functional studies indicated the transactivation capacity of mutant PITX2 on Distal-less homeobox 2 (DLX2) promoter was compromised. The maxillary teeth showed significantly higher rate of agenesis (57.94%) than the mandibular teeth (44.05%). The most often missing teeth were upper lateral incisors (83.33%) and upper second premolars (69.44%). Teeth with the least agenesis rate were the lower second molars (19.44%) and lower first molars (8.33%). CONCLUSIONS We identified a novel 4q25 microdeletion including PITX2 and three novel PITX2 mutations, and statistically analyzed the PITX2-related tooth agenesis pattern.
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Affiliation(s)
- Zhuangzhuang Fan
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Clinical Research Center for Oral Diseases, Beijing, China
- Peking University School and Hospital of Stomatology, Beijing, China
| | - Shichen Sun
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Clinical Research Center for Oral Diseases, Beijing, China
- Peking University School and Hospital of Stomatology, Beijing, China
| | - Haochen Liu
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Clinical Research Center for Oral Diseases, Beijing, China
- Peking University School and Hospital of Stomatology, Beijing, China
| | - Miao Yu
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Clinical Research Center for Oral Diseases, Beijing, China
- Peking University School and Hospital of Stomatology, Beijing, China
| | - Ziyuan Liu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Sing-Wai Wong
- Division of Comprehensive Oral Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, NC, USA
| | - Yang Liu
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Clinical Research Center for Oral Diseases, Beijing, China
- Peking University School and Hospital of Stomatology, Beijing, China
| | - Dong Han
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Clinical Research Center for Oral Diseases, Beijing, China
- Peking University School and Hospital of Stomatology, Beijing, China
| | - Hailan Feng
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Clinical Research Center for Oral Diseases, Beijing, China
- Peking University School and Hospital of Stomatology, Beijing, China
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10
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Chrystal PW, Walter MA. Aniridia and Axenfeld-Rieger Syndrome: Clinical presentations, molecular genetics and current/emerging therapies. Exp Eye Res 2019; 189:107815. [PMID: 31560925 DOI: 10.1016/j.exer.2019.107815] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/11/2019] [Accepted: 09/23/2019] [Indexed: 12/20/2022]
Abstract
Aniridia and Axenfeld-Rieger Syndrome are related, human ocular disorders that are typically inherited in an autosomal dominant manner. Both result from incorrect development of the eye and have, as their most serious consequences, elevated risk to develop the blinding condition glaucoma. This review will focus on describing the clinical presentations of Aniridia and Axenfeld-Rieger Syndrome as well as the molecular genetics and current and emerging therapies used to treat patients.
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Affiliation(s)
- Paul W Chrystal
- Department of Medical Genetics, University of Alberta, Edmonton, AB, Canada
| | - Michael A Walter
- Department of Medical Genetics, University of Alberta, Edmonton, AB, Canada.
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11
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Williams MA, Letra A. The Changing Landscape in the Genetic Etiology of Human Tooth Agenesis. Genes (Basel) 2018; 9:genes9050255. [PMID: 29772684 PMCID: PMC5977195 DOI: 10.3390/genes9050255] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/01/2018] [Accepted: 05/09/2018] [Indexed: 02/08/2023] Open
Abstract
Despite much progress in understanding the genetics of syndromic tooth agenesis (TA), the causes of the most common, isolated TA remain elusive. Recent studies have identified novel genes and variants contributing to the etiology of TA, and revealed new pathways in which tooth development genes belong. Further, the use of new research approaches including next-generation sequencing has provided increased evidence supporting an oligogenic inheritance model for TA, and may explain the phenotypic variability of the condition. In this review, we present current knowledge about the genetic mechanisms underlying syndromic and isolated TA in humans, and highlight the value of incorporating next-generation sequencing approaches to identify causative and/or modifier genes that contribute to the etiology of TA.
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Affiliation(s)
- Meredith A Williams
- University of Texas Health Science Center at Houston School of Dentistry, Houston, TX 77054, USA.
| | - Ariadne Letra
- Department of Diagnostic and Biomedical Sciences, University of Texas Health Science Center at Houston School of Dentistry, Houston, TX 77054, USA.
- Center for Craniofacial Research, University of Texas Health Science Center at Houston School of Dentistry, Houston, TX 77054, USA.
- Pediatric Research Center, University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX 77030, USA.
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Seifi M, Walter MA. Axenfeld-Rieger syndrome. Clin Genet 2018; 93:1123-1130. [PMID: 28972279 DOI: 10.1111/cge.13148] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 09/23/2017] [Accepted: 09/26/2017] [Indexed: 12/29/2022]
Abstract
Axenfeld-Rieger syndrome (ARS) is a clinically and genetically heterogeneous group of developmental disorders affecting primarily the anterior segment of the eye, often leading to secondary glaucoma. Patients with ARS may also present with systemic changes, including dental defects, mild craniofacial dysmorphism, and umbilical anomalies. ARS is inherited in an autosomal-dominant fashion; the underlying defect in 40% of patients is mutations in PITX2 or FOXC1. Here, an overview of the clinical spectrum of ARS is provided. As well, the known underlying genetic defects, clinical diagnostic possibilities, genetic counseling and treatments of ARS are discussed in detail.
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Affiliation(s)
- M Seifi
- Department of Medical Genetics, Faculty of Medicine and Dentistry, University of Alberta, Alberta, Edmonton, Canada
| | - M A Walter
- Department of Medical Genetics, Faculty of Medicine and Dentistry, University of Alberta, Alberta, Edmonton, Canada
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13
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The Rieger syndrome: A case report with unusual dental findings. BALKAN JOURNAL OF DENTAL MEDICINE 2018. [DOI: 10.2478/bjdm-2018-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background/Aim: The Rieger syndrome is a rare, autosomal dominant and phenotypically variable disorder, characterized by abnormalities of the anterior chamber of the eye, coincident with missing or misshapen teeth. Case report: This report features a case of the Rieger syndrome associated with bilateral cleft lip and palate and a severe open bite, findings not usually reported in association with this condition. Conclusions: The findings described in the present case of Rieger syndrome are unusual and expand the spectrum of manifestations of the condition.
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Velopharyngeal Insufficiency After Le Fort I Osteotomy in a Patient With Undiagnosed Occult Submucous Cleft Palate. J Craniofac Surg 2017; 28:752-754. [DOI: 10.1097/scs.0000000000003427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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15
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Affiliation(s)
- A. Craig Dunbar
- Orthodontic Department, Dundee Dental Hospital and School, Scotland, UK
| | - Grant T. McIntyre
- Orthodontic Department, Dundee Dental Hospital and School, Scotland, UK
| | - Sean Laverick
- Oral and Maxillofacial Department, Ninewells Hospital, Dundee Scotland, UK
| | - Brian Stevenson
- Restorative Dentistry Department, Dundee Dental Hospital and School, Scotland, UK
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Huang Z, Hu X, Lin C, Chen S, Huang F, Zhang Y. Genome-wide analysis of gene expression in human embryonic tooth germ. J Mol Histol 2014; 45:609-17. [DOI: 10.1007/s10735-014-9580-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 06/11/2014] [Indexed: 10/24/2022]
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17
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Li X, Venugopalan SR, Cao H, Pinho FO, Paine ML, Snead ML, Semina EV, Amendt BA. A model for the molecular underpinnings of tooth defects in Axenfeld-Rieger syndrome. Hum Mol Genet 2014; 23:194-208. [PMID: 23975681 PMCID: PMC3857954 DOI: 10.1093/hmg/ddt411] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 08/19/2013] [Indexed: 12/18/2022] Open
Abstract
Patients with Axenfeld-Rieger Syndrome (ARS) present various dental abnormalities, including hypodontia, and enamel hypoplasia. ARS is genetically associated with mutations in the PITX2 gene, which encodes one of the earliest transcription factors to initiate tooth development. Thus, Pitx2 has long been considered as an upstream regulator of the transcriptional hierarchy in early tooth development. However, because Pitx2 is also a major regulator of later stages of tooth development, especially during amelogenesis, it is unclear how mutant forms cause ARS dental anomalies. In this report, we outline the transcriptional mechanism that is defective in ARS. We demonstrate that during normal tooth development Pitx2 activates Amelogenin (Amel) expression, whose product is required for enamel formation, and that this regulation is perturbed by missense PITX2 mutations found in ARS patients. We further show that Pitx2-mediated Amel activation is controlled by chromatin-associated factor Hmgn2, and that Hmgn2 prevents Pitx2 from efficiently binding to and activating the Amel promoter. Consistent with a physiological significance to this interaction, we show that K14-Hmgn2 transgenic mice display a severe loss of Amel expression on the labial side of the lower incisors, as well as enamel hypoplasia-consistent with the human ARS phenotype. Collectively, these findings define transcriptional mechanisms involved in normal tooth development and shed light on the molecular underpinnings of the enamel defect observed in ARS patients who carry PITX2 mutations. Moreover, our findings validate the etiology of the enamel defect in a novel mouse model of ARS.
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Affiliation(s)
- Xiao Li
- Department of Anatomy and Cell Biology and Craniofacial Anomalies Research Center, The University of Iowa, Iowa City, IA 52244, USA
| | - Shankar R. Venugopalan
- Department of Anatomy and Cell Biology and Craniofacial Anomalies Research Center, The University of Iowa, Iowa City, IA 52244, USA
| | - Huojun Cao
- Department of Anatomy and Cell Biology and Craniofacial Anomalies Research Center, The University of Iowa, Iowa City, IA 52244, USA
| | - Flavia O. Pinho
- Department of Anatomy and Cell Biology and Craniofacial Anomalies Research Center, The University of Iowa, Iowa City, IA 52244, USA
| | - Michael L. Paine
- Center for Craniofacial Molecular Biology, Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA and
| | - Malcolm L. Snead
- Center for Craniofacial Molecular Biology, Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA and
| | - Elena V. Semina
- Division of Developmental Biology, Department of Pediatrics, The Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Brad A. Amendt
- Department of Anatomy and Cell Biology and Craniofacial Anomalies Research Center, The University of Iowa, Iowa City, IA 52244, USA
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Bender CA, Koudstaal MJ, van Elswijk JFA, Prahl C, Wolvius EB. Two cases of axenfeld-rieger syndrome, report of the complex pathology and treatment. Cleft Palate Craniofac J 2013; 51:354-60. [PMID: 23886080 DOI: 10.1597/12-295] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The purpose of this case report is to report the orthodontic surgical treatment and subsequent dental rehabilitation in two patients with Axenfeld-Rieger syndrome. Axenfeld-Rieger syndrome is a rare autosomal dominant condition characterized by ocular, dental, craniofacial, and periumbilical abnormalities. The treatment of two patients with various anomalies in Axenfeld-Rieger syndrome is described and discussed. Early recognition of the syndrome and referral during childhood to a specialized oral and maxillofacial surgery, special dental care, and orthodontic unit provide the optimal starting point for this complex treatment.
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Heliövaara A, Rantanen I, Arte S. Dental development and tooth agenesis in children with velocardiofacial syndrome. Int J Paediatr Dent 2011; 21:446-50. [PMID: 21689177 DOI: 10.1111/j.1365-263x.2011.01148.x] [Citation(s) in RCA: 12] [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
BACKGROUND. Variations in dental development and tooth agenesis have been reported in children with velocardiofacial syndrome (VCFS). AIM. The aim was to evaluate the dental development and missing permanent teeth in children with VCFS. DESIGN. Forty-five children (23 girls) with VCFS who had visited the cleft palate and craniofacial centre were studied retrospectively from orthopantomograms taken at the mean age of 7.9 years (range 5.8-12.9). Thirteen of the children with VCFS had palatal clefts. The deletion of 22q11 was verified by FISH techniques. The dental stages were assessed by the method of Demirjian, and the dental age was calculated according to the Finnish dental maturity reference values. A paired Student's t-test was used in the statistical analysis. RESULTS. Eight children (17%), four with palatal clefts, had tooth agenesis. Four children (9%) had agenesis of mandibular incisors. The missing teeth (n = 19) were mainly mandibular incisors (n = 6), maxillary lateral incisors (n = 2), and maxillary second premolars (n = 4). The dental age of the children with VCFS was not different from their chronological age, but there was great individual variation. CONCLUSIONS. A high prevalence of missing permanent teeth, especially mandibular incisors, was observed. The need for thorough clinical and radiological dental examination in children with VCFS is emphasized.
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Affiliation(s)
- Arja Heliövaara
- Cleft Palate and Craniofacial Center, Department of Plastic Surgery, Helsinki University Central Hospital.
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Waldron JM, McNamara C, Hewson AR, McNamara CM. Axenfeld-Rieger syndrome (ARS): A review and case report. SPECIAL CARE IN DENTISTRY 2010; 30:218-22. [PMID: 20831741 DOI: 10.1111/j.1754-4505.2010.00153.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Axenfeld-Rieger syndrome (ARS) is a rare, autosomal dominant condition characterized by ocular, craniofacial, dental, and periumbilical abnormalities. Relatively little information exists on this syndrome within the dental literature despite the fact that midface hypoplasia and maxillary hypodontia are classical presenting features of this syndrome. This is a case report of a 7-year-old Caucasian female with ARS who presented with significant ocular and dental anomalies. She was also found to have osteopenia. Her dental condition is described, her immediate treatment is shown, and her long-term treatment needs are discussed.
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Dental and Craniofacial Anomalies Associated with Axenfeld-Rieger Syndrome with PITX2 Mutation. Case Rep Med 2010; 2010:621984. [PMID: 20339518 PMCID: PMC2842968 DOI: 10.1155/2010/621984] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2009] [Accepted: 01/11/2010] [Indexed: 11/26/2022] Open
Abstract
Axenfeld-Rieger syndrome (ARS) (OMIM Nr.: 180500) is a rare autosomal dominant disorder (1 : 200000) with genetic and morphologic variability. Glaucoma is associated in 50% of the patients. Craniofacial and dental anomalies are frequently reported with ARS. The present study was designed as a multidisciplinary analysis of orthodontic, ophthalmologic, and genotypical features. A three-generation pedigree was ascertained through a family with ARS. Clinically, radiographic and genetic analyses were performed. Despite an identical genotype in all patients, the phenotype varies in expressivity of craniofacial and dental morphology. Screening for PITX2 and FOXC1 mutations by direct DNA-sequencing revealed a P64L missense mutation in PITX2 in all family members, supporting earlier reports that PITX2 is an essential factor in morphogenesis of teeth and craniofacial skeleton. Despite the fact that the family members had identical mutations, morphologic differences were evident. The concomitant occurrence of rare dental and craniofacial anomalies may be early diagnostic indications of ARS. Early detection of ARS and elevated intraocular pressure (IOP) helps to prevent visual field loss.
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