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Genetics of Obesity in Humans: A Clinical Review. Int J Mol Sci 2022; 23:ijms231911005. [PMID: 36232301 PMCID: PMC9569701 DOI: 10.3390/ijms231911005] [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: 07/31/2022] [Revised: 09/09/2022] [Accepted: 09/10/2022] [Indexed: 11/23/2022] Open
Abstract
Obesity is a complex multifactorial disorder with genetic and environmental factors. There is an increase in the worldwide prevalence of obesity in both developed and developing countries. The development of genome-wide association studies (GWAS) and next-generation sequencing (NGS) has increased the discovery of genetic associations and awareness of monogenic and polygenic causes of obesity. The genetics of obesity could be classified into syndromic and non-syndromic obesity. Prader–Willi, fragile X, Bardet–Biedl, Cohen, and Albright Hereditary Osteodystrophy (AHO) syndromes are examples of syndromic obesity, which are associated with developmental delay and early onset obesity. Non-syndromic obesity could be monogenic, polygenic, or chromosomal in origin. Monogenic obesity is caused by variants of single genes while polygenic obesity includes several genes with the involvement of members of gene families. New advances in genetic testing have led to the identification of obesity-related genes. Leptin (LEP), the leptin receptor (LEPR), proopiomelanocortin (POMC), prohormone convertase 1 (PCSK1), the melanocortin 4 receptor (MC4R), single-minded homolog 1 (SIM1), brain-derived neurotrophic factor (BDNF), and the neurotrophic tyrosine kinase receptor type 2 gene (NTRK2) have been reported as causative genes for obesity. NGS is now in use and emerging as a useful tool to search for candidate genes for obesity in clinical settings.
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Yang-Li D, Fei-Hong L, Hui-Wen Z, Ming-Sheng M, Xiao-Ping L, Li L, Yi W, Qing Z, Yong-Hui J, Chao-Chun Z. Recommendations for the diagnosis and management of childhood Prader-Willi syndrome in China. Orphanet J Rare Dis 2022; 17:221. [PMID: 35698200 PMCID: PMC9195308 DOI: 10.1186/s13023-022-02302-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/23/2022] [Indexed: 11/28/2022] Open
Abstract
Prader-Willi syndrome (PWS) is a complex and multisystem neurobehavioral disease, which is caused by the lack of expression of paternally inherited imprinted genes on chromosome15q11.2-q13.1. The clinical manifestations of PWS vary with age. It is characterized by severe hypotonia with poor suck and feeding difficulties in the early infancy, followed by overeating in late infancy or early childhood and progressive development of morbid obesity unless the diet is externally controlled. Compared to Western PWS patients, Chinese patients have a higher ratio of deletion type. Although some rare disease networks, including PWS Cooperation Group of Rare Diseases Branch of Chinese Pediatric Society, Zhejiang Expert Group for PWS, were established recently, misdiagnosis, missed diagnosis and inappropriate intervention were usually noted in China. Therefore, there is an urgent need for an integrated multidisciplinary approach to facilitate early diagnosis and optimize management to improve quality of life, prevent complications, and prolong life expectancy. Our purpose is to evaluate the current literature and evidences on diagnosis and management of PWS in order to provide evidence-based guidelines for this disease, specially from China.
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Affiliation(s)
- Dai Yang-Li
- Children's Hospital of Zhejiang University School of Medicine, No. 3333 Binsheng Road, Hangzhou, 310003, China
| | - Luo Fei-Hong
- Children's Hospital of Fudan University, Shanghai, China
| | - Zhang Hui-Wen
- Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ma Ming-Sheng
- Peking Union Medical College Hospital, Beijing, China
| | - Luo Xiao-Ping
- Tongji Hospital, Tongji Medical College of HUST, Wuhan, China
| | - Liu Li
- Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Wang Yi
- Children's Hospital of Fudan University, Shanghai, China
| | - Zhou Qing
- Fujian Children's Hospital, Fuzhou, China
| | - Jiang Yong-Hui
- Yale University, 69 Lexington Gardens, Northern Haven, CT, 06473, USA.
| | - Zou Chao-Chun
- Children's Hospital of Zhejiang University School of Medicine, No. 3333 Binsheng Road, Hangzhou, 310003, China.
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Prenatal and Neonatal Characteristics of Children with Prader-Willi Syndrome. J Clin Med 2022; 11:jcm11030679. [PMID: 35160130 PMCID: PMC8837147 DOI: 10.3390/jcm11030679] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 12/10/2022] Open
Abstract
Objective: Prader-Willi syndrome (PWS) is a rare genetic syndrome with a wide spectrum of clinical features in early life. Late diagnoses are still present. We characterized the perinatal and neonatal features of PWS, compared them with those of healthy newborns and assessed the prenatal and neonatal differences between the genetic subtypes. Design: A cohort study in children with PWS. The prevalence of variables was compared with healthy infants (PLUTO cohort) and to population statistics from literature. Patients: 244 infants with PWS and 365 healthy infants. Measurements: Data on prenatal and neonatal variables in both cohorts. Population statistics were collected through an extensive literature search. Results: A higher prevalence of maternal age >35 years was found in PWS compared to healthy infants and population statistics, and the highest maternal age was found in the mUPD group. Higher prevalence of polyhydramnios, caesarean section, labour induction and breech presentation, and lower birth weight SDS was found in PWS compared to healthy infants. High prevalences of decreased fetal movements (78.5%), hypotonia (100%), cryptorchism (95.9%) and poor sucking/tube feeding (93.9%) were found in PWS. Conclusions: This study presents an overview of prenatal and neonatal variables in infants with PWS compared to healthy infants. Our findings may increase clinical awareness of the early perinatal signs of PWS by obstetricians, neonatologists and all those involved in infant care, enabling early diagnosis and start of multidisciplinary treatment.
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Amaro AS, Rubin DA, Teixeira MCTV, Ferreira AJ, Rodrigues GM, Carreiro LRR. Health Problems in Individuals With PWS Are Associated With Lower Quality of Life for Their Parents: A Snapshot in the Brazilian Population. Front Pediatr 2022; 10:746311. [PMID: 35242723 PMCID: PMC8885721 DOI: 10.3389/fped.2022.746311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 01/03/2022] [Indexed: 11/13/2022] Open
Abstract
Prader-Willi syndrome (PWS) is a complex genetic disorder requiring interdisciplinary team monitoring and intensive care by parents. So far there is little information on people with PWS in Brazil. Our aim was to describe health problems and treatments used by people with PWS in Brazil and their relationship to their parents' quality of life. Parents answered questionnaires about their child's medical and exercise history, behavior problems, sociodemographic characteristics, and their own quality of life. Results: The responses of the participants showed similar health problems as in other countries. Anxiety and tantrums were the behavioral problems most commonly cited by parents. Parents of people with PWS had lower scores in respect of quality of life than the Brazilian population. Behavioral problems in individuals with PWS were negatively associated with their parents' quality of life. Behavioral and medical conditions in the children were associated with reduced quality of life in the parents. We conclude that heath care should not only be directed toward those with PWS, but also their parents.
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Affiliation(s)
- Alexandre Slowetzky Amaro
- Development Disorders Graduate Program, Center for Health and Biological Science, Universidade Presbiteriana Mackenzie, São Paulo, Brazil
| | - Daniela Andrea Rubin
- Department of Kinesiology, California State University, Fullerton, CA, United States
| | | | - Arcenio José Ferreira
- Development Disorders Graduate Program, Center for Health and Biological Science, Universidade Presbiteriana Mackenzie, São Paulo, Brazil
| | - Graciele Massoli Rodrigues
- Physical Education Program, Universidade São Judas Tadeu, São Paulo, Brazil.,Physical Education Program, Escola Superior de Educação Física de Jundiaí, Jundiaí, Brazil
| | - Luiz Renato Rodrigues Carreiro
- Development Disorders Graduate Program, Center for Health and Biological Science, Universidade Presbiteriana Mackenzie, São Paulo, Brazil
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Correlation of Genotype and Perinatal Period, Time of Diagnosis and Anthropometric Data before Commencement of Recombinant Human Growth Hormone Treatment in Polish Patients with Prader-Willi Syndrome. Diagnostics (Basel) 2021; 11:diagnostics11050798. [PMID: 33925106 PMCID: PMC8145028 DOI: 10.3390/diagnostics11050798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/23/2021] [Accepted: 04/24/2021] [Indexed: 01/01/2023] Open
Abstract
Genotype-phenotype correlation in patients with Prader-Willi syndrome (PWS) has still not been fully described. We retrospectively analysed data of 147 patients and compared groups according to genetic diagnosis: paternal deletion of chromosome 15q11-q13 (DEL 15, n = 81), maternal uniparental disomy (UPD 15, n = 10), excluded DEL 15 (UPD 15 or imprinting centre defect, UPD/ID, n = 30). Group DEL 15 had an earlier genetic diagnosis and recombinant human growth hormone (rhGH) start (p = 0.00), with a higher insulin-like growth factor 1 (IGF1) level compared to group UPD/ID (p = 0.04). Among perinatal characteristics, there was only a tendency towards lower birth weight SDS in group UPD 15 (p = 0.06). We also compared data at rhGH start in relation to genetic diagnosis age-group 1: age ≤9 months, group 2: >9 months ≤ 2 years, group 3: > 2 years. Group 1 had the earliest rhGH start (p = 0.00), with lower body mass index (BMI) SDS (p = 0.00) and a tendency towards a higher IGF1 level compared to group 3 (p = 0.05). Genetic background in children with PWS is related to time of diagnosis and rhGH start, with a difference in IGF1 level before the therapy, but it seems to have little impact on perinatal data. Early genetic diagnosis leads to early rhGH treatment with favourable lower BMI SDS.
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Dong GQ, Su YY, Qiu XY, Lu XY, Li JX, Huang M, Luo XP. [Clinical screening and genetic diagnosis for Prader-Willi syndrome]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:1001-1006. [PMID: 32933634 PMCID: PMC7499446 DOI: 10.7499/j.issn.1008-8830.2003344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/27/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To study the clinical screening and genetic diagnosis of children suspected of Prader-Willi syndrome (PWS), as well as the differences in the scores of clinical diagnostic criteria among the children with a confirmed diagnosis of PWS. METHODS A total of 94 children suspected of PWS who were admitted from July 2016 to December 2018 were enrolled as subjects. Methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) was performed to confirm the diagnosis. For the children with a confirmed diagnosis of PWS, the scores of clinical diagnostic criteria were determined, and the perinatal characteristics were analyzed. RESULTS A total of 11 children with PWS were confirmed by MS-MLPA, with a detection rate of 12%, among whom there were 7 boys and 4 girls, with a median age of 3 years and 4 months (range 25 days to 6 years and 8 months) at the time of confirmed diagnosis. Among the 11 children with PWS, only 5 children (45%) met the criteria for clinical diagnosis. The main perinatal characteristics of the children with PWS were decreased fetal movement (9 cases, 82%), cesarean section birth (11 cases, 100%), hypotonia (11 cases, 100%), feeding difficulties (11 cases, 100%), and weak crying (11 cases, 100%). CONCLUSIONS Gene testing should be performed as early as possible for children suspected of PWS by clinical screening. PWS may be missed if only based on the scores of clinical diagnostic criteria.
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Affiliation(s)
- Guo-Qing Dong
- Department of Pediatrics, Shenzhen Maternity & Child Healthcare Hospital Affiliated to Southern Medical University, Shenzhen, Guangdong 518028, China.
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Yang L, Zhou Q, Ma B, Mao S, Dai Y, Zhu M, Zou C. Perinatal features of Prader-Willi syndrome: a Chinese cohort of 134 patients. Orphanet J Rare Dis 2020; 15:24. [PMID: 31964399 PMCID: PMC6975078 DOI: 10.1186/s13023-020-1306-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/14/2020] [Indexed: 01/16/2023] Open
Abstract
Background Prader-Willi syndrome (PWS) is a rare and complex genetic disorder caused by lacking expression of imprinted genes on the paternally derived chromosome 15q11-q13 region. This study aimed to characterize the perinatal features of 134 Chinese individuals with PWS. Methods This study included the patients of a PWS registry in China. Anonymous data of 134 patients were abstracted. Perinatal and neonatal presentations were analyzed, and compared between the two PWS genetic subtypes. We also compared the perinatal features of PWS patients with the general population and other previous reported large cohorts from France, UK and USA. Results This study included 134 patients with PWS (115 patients with 15q11-q13 deletion and 19 with maternal uniparental disomy). Higher mean maternal age was found in this cohort (30.5 vs. 26.7), particularly in the maternal uniparental disomy (UPD) group (36.0 vs. 26.7) comparing with the general population. 88.6% of mothers reported a decrease of fetal movements. 42.5 and 18.7% of mothers had polyhydramnios and oligohydramnios during pregnancy, respectively. 82.8% of the patients were born by caesarean section. 32.1% of neonates had birth asphyxia, 98.5% had hypotonia and 97.8% had weak cry or even no cry at neonatal period. Feeding difficulty existed in 99.3% of the infants, 94.8% of whom had failure to thrive. 69.4% of the infants ever used feeding tube during hospitalization, however, 97.8% of them discontinued tube feeding after discharge. Maternal age and pre-pregnancy weight were significantly higher in the UPD group (both P < 0.05). Conclusions Differential diagnosis of PWS should be highlighted if infants having following perinatal factors including polyhydramnios, decreased intrauterine fetal movements, caesarean section, low birth weight, feeding difficulty, hypotonia and failure to thrive. Higher maternal age may be a risk factor of PWS, especially for UPD. Further studies are needed for elucidating the mechanism of PWS.
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Affiliation(s)
- Lili Yang
- Department of Genetics and Metabolism, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Qiong Zhou
- Department of Endocrinology and Metabolism, Hangzhou Children's Hospital, Hangzhou, China
| | - Bo Ma
- Department of Obstetrics and Gynecology, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China
| | - Shujiong Mao
- Department of Pediatrics, Hangzhou First People's Hospital, Zhejiang University School of Medicine , Hangzhou, China
| | - Yanli Dai
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Binsheng Rd, Hangzhou 310052, China
| | - Mingqiang Zhu
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Binsheng Rd, Hangzhou 310052, China
| | - Chaochun Zou
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Binsheng Rd, Hangzhou 310052, China.
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El-Bassyouni HT, Hassan N, Mahfouz I, Abd-Elnaby AE, Mostafa MI, Tosson AMS. Early Detection and Management of Prader-Willi Syndrome in Egyptian Patients. J Pediatr Genet 2019; 8:179-186. [PMID: 31687254 DOI: 10.1055/s-0039-1695042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/13/2019] [Indexed: 10/26/2022]
Abstract
Prader-Willi syndrome (PWS) is a distinct neurodevelopmental disorder associated with the deletion within the chromosomal 15q11-q13 region or uniparental disomy of chromosome 15. The etiologic heterogeneity of PWS makes it very difficult to establish uniform diagnostic methods which would result in the detection of most affected individuals. The objective was to report the clinical criteria and oro-dental features in PWS, to report the effect of diet and laser acupuncture on PWS and highlighted an easy effective method for early diagnosis of individuals with PWS. The study included seventeen cytogenetically proven individuals with Prader-Willi syndrome. These patients were subjected to meticulous history taking, clinical examination including oro-dental examination, bone densitometry and neuropsychiatric evaluation. They received laser acupuncture sessions in addition to nutrition intervention. All cases had characteristic facies, hypotonia and various psychosocial difficulties. Other criteria of PWS were present in different percentages. Karyotyping revealed deletion 15q11-q13 in 6 patients, and fluorescence in situ hybridization (FISH) revealed a microdeletion in 15q11-q13 in the other 11 patients. To our knowledge, partial ankyloglossia, median grooved tongue and hypodontia have not previously been reported in PWS patients. Laser acupuncture sessions and diet were effective in weight decline for PWS patients. Our study emphasizes the importance of early detection of PWS, laser sessions, diet restriction and oro-dental examination in the follow up of patients with Prader Willi syndrome.
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Affiliation(s)
| | - Nagwa Hassan
- Department of Nutrition, National Research Centre, Cairo, Egypt
| | - Inas Mahfouz
- Department of Nutrition, National Research Centre, Cairo, Egypt
| | - Azza E Abd-Elnaby
- Department of Human Cytogenetics, National Research Centre, Cairo, Egypt
| | - Mostafa I Mostafa
- Department of Oro-dental Genetics, National Research Centre, Cairo, Egypt
| | - Angie M S Tosson
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
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Pacoricona Alfaro DL, Lemoine P, Ehlinger V, Molinas C, Diene G, Valette M, Pinto G, Coupaye M, Poitou-Bernert C, Thuilleaux D, Arnaud C, Tauber M. Causes of death in Prader-Willi syndrome: lessons from 11 years' experience of a national reference center. Orphanet J Rare Dis 2019; 14:238. [PMID: 31684997 PMCID: PMC6829836 DOI: 10.1186/s13023-019-1214-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/24/2019] [Indexed: 12/12/2022] Open
Abstract
Background In the last 20 years, substantial improvements have been made in the diagnosis, treatment and management of patients with Prader-Willi syndrome (PWS). Few data on causes of death are available since those improvements were made. Our study assessed the causes of death among French patients with PWS over the first 11 years of experience of the nationwide French Reference Center for PWS (FRC-PWS). Methods Our study relied on two sources of mortality information at national level between 2004 and 2014: The French Epidemiological Centre for the Medical Causes of Death (CépiDc) Registry and the FRC-PWS database. Causes of death were classified into seven categories: respiratory, cardiovascular, gastrointestinal, severe infection, sudden death, other causes, and unknown. Descriptive statistics were calculated separately for children (< 18 years-old) and adults (≥18 years-old). Results One hundred and four deaths were identified in France from 2004 to 2014. The median age at death was 30 years, ranging from less than 1 month to 58 years. Seventeen deaths occurred in patients under 18 years, with 70% of them in children under 2 years. Respiratory causes accounted for more than 50% of the deaths in patients with PWS in both children and adults. Both cause and age of death did not significantly differ according to gender or genetic subtype. Conclusions Patients with PWS die prematurely due to a respiratory cause in most cases at all ages. In those adult patients with data on obesity, 98% were reported to be obese.
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Affiliation(s)
| | - Perrine Lemoine
- Endocrinology, Obesity, Bone Diseases, Genetics and Gynecology Unit, Children's Hospital, University Hospital Center of Toulouse, Toulouse, France
| | | | - Catherine Molinas
- Endocrinology, Obesity, Bone Diseases, Genetics and Gynecology Unit, Children's Hospital, University Hospital Center of Toulouse, Toulouse, France.,French National Reference Center for Prader-Willi Syndrome, Children's Hospital, University Hospital Center of Toulouse, 330, avenue de Grande-Bretagne - TSA 40031, 31059, Toulouse cedex 9, France.,Centre de Physiopathologie de Toulouse-Purpan, UMR 5282 CNRS, UMR 1043 Inserm, Paul Sabatier University, Toulouse, France
| | - Gwénaëlle Diene
- UMR 1027 Inserm- Paul Sabatier University, Toulouse, France.,Endocrinology, Obesity, Bone Diseases, Genetics and Gynecology Unit, Children's Hospital, University Hospital Center of Toulouse, Toulouse, France.,French National Reference Center for Prader-Willi Syndrome, Children's Hospital, University Hospital Center of Toulouse, 330, avenue de Grande-Bretagne - TSA 40031, 31059, Toulouse cedex 9, France
| | - Marion Valette
- Endocrinology, Obesity, Bone Diseases, Genetics and Gynecology Unit, Children's Hospital, University Hospital Center of Toulouse, Toulouse, France.,French National Reference Center for Prader-Willi Syndrome, Children's Hospital, University Hospital Center of Toulouse, 330, avenue de Grande-Bretagne - TSA 40031, 31059, Toulouse cedex 9, France
| | - Graziella Pinto
- Pediatric Endocrinology, Diabetology and Gynecology Department, Assistance-Publique Hôpitaux de Paris (AP-HP), Necker Children's University Hospital, Paris, France
| | - Muriel Coupaye
- French National Reference Center for Prader-Willi Syndrome, Nutrition Department, Assistance-Publique Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Paris, France
| | - Christine Poitou-Bernert
- French National Reference Center for Prader-Willi Syndrome, Nutrition Department, Assistance-Publique Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Paris, France.,Nutriomics team, Sorbonne University, UPMC University Paris 06, Inserm, Paris, France
| | - Denise Thuilleaux
- French National Reference Center for Prader-Willi Syndrome, Prader-Willi Unit, Assistance Publique Hôpitaux de Paris (AP-HP), Marine Hendaye Hospital, Hendaye, France
| | - Catherine Arnaud
- UMR 1027 Inserm- Paul Sabatier University, Toulouse, France.,Unité de Soutien Méthodologique à la Recherche, University Hospital Center of Toulouse, Toulouse, France
| | - Maithé Tauber
- Endocrinology, Obesity, Bone Diseases, Genetics and Gynecology Unit, Children's Hospital, University Hospital Center of Toulouse, Toulouse, France. .,French National Reference Center for Prader-Willi Syndrome, Children's Hospital, University Hospital Center of Toulouse, 330, avenue de Grande-Bretagne - TSA 40031, 31059, Toulouse cedex 9, France. .,Centre de Physiopathologie de Toulouse-Purpan, UMR 5282 CNRS, UMR 1043 Inserm, Paul Sabatier University, Toulouse, France.
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Pansy J, Barones C, Urlesberger B, Pokorny FB, Bartl-Pokorny KD, Verheyen S, Marschik PB, Einspieler C. Early motor and pre-linguistic verbal development in Prader-Willi syndrome - A case report. RESEARCH IN DEVELOPMENTAL DISABILITIES 2019; 88:16-21. [PMID: 30825843 DOI: 10.1016/j.ridd.2019.01.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 10/26/2018] [Accepted: 01/29/2019] [Indexed: 05/27/2023]
Abstract
BACKGROUND Prader-Willi syndrome (PWS) is a rare genetic disorder. Infants with PWS show a neurodevelopmental dysfunction which entails a delayed motor and language development, but studies on their spontaneous movements (i.e. general movements) or pre-linguistic speech-language development before 6 months of age are missing so far. AIM To describe early motor and pre-linguistic verbal development in an infant with PWS. METHODS AND PROCEDURES Prospective case report; in addition to the assessment of general movements and the concurrent movement repertoire, we report on early verbal forms, applying the Stark Assessment of Early Vocal Development-Revised. OUTCOMES AND RESULTS General movements were abnormal on days 8 and 15. No fidgety movements were observed at 11 weeks; they only emerged at 17 weeks and lasted until at least 27 weeks post-term. The movement character was monotonous, and early motor milestones were only achieved with a delay. At 27 weeks the infant produced age-adequate types of vocalisations. However, none of the canonical-syllable vocalisations that typically emerge at that age were observed. Early vocalisations appeared monotonous and with a peculiarly harmonic structure. CONCLUSIONS AND IMPLICATIONS Early motor and pre-linguistic verbal behaviours were monotonous in an infant with PWS throughout his first 6 months of life. This suggests that early signs of neurodevelopmental dysfunction (i.e. abnormal general movements) might already be diagnosed in infants with PWS during their first weeks of life, potentially enabling us to diagnose and intervene at an early stage.
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Affiliation(s)
- Jasmin Pansy
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.
| | - Cornelia Barones
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Berndt Urlesberger
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Florian B Pokorny
- iDN - Interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Medical University of Graz, Graz, Austria; Machine Intelligence & Signal Processing Group, MMK, Technical University of Munich, Munich, Germany
| | - Katrin D Bartl-Pokorny
- iDN - Interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Medical University of Graz, Graz, Austria
| | - Sarah Verheyen
- Institute of Human Genetics, Medical University of Graz, Graz, Austria
| | - Peter B Marschik
- iDN - Interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Medical University of Graz, Graz, Austria; Child and Adolescent Psychiatry and Psychotherapy, iDN - Interdisciplinary Developmental Neuroscience, University Medical Center Goettingen, Goettingen, Germany; Center of Neurodevelopmental Disorders (KIND), Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Christa Einspieler
- iDN - Interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Medical University of Graz, Graz, Austria
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Mahmoud R, Singh P, Weiss L, Lakatos A, Oakes M, Hossain W, Butler MG, Kimonis V. Newborn screening for Prader-Willi syndrome is feasible: Early diagnosis for better outcomes. Am J Med Genet A 2018; 179:29-36. [PMID: 30556641 DOI: 10.1002/ajmg.a.60681] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/15/2018] [Accepted: 09/17/2018] [Indexed: 12/26/2022]
Abstract
Prader-Willi syndrome (PWS), is a complex genetic disease affecting 1/15,000 individuals, characterized by lack of expression of genes on the paternal chromosome 15q11-q13 region. Clinical features include central hypotonia, poor suck, learning and behavior problems, growth hormone deficiency with short stature, hyperphagia, and morbid obesity. Despite significant advances in genetic testing, the mean age for diagnosis in PWS continues to lag behind. Our goal was to perform a pilot feasibility study to confirm the diagnosis utilizing different genetic technologies in a cohort of 34 individuals with genetically confirmed PWS and 16 healthy controls from blood samples spotted and stored on newborn screening (NBS) filter paper cards. DNA was isolated from NBS cards, and PWS testing performed using DNA methylation-specific PCR (mPCR) and the methylation specific-multiplex ligation dependent probe amplification (MS-MLPA) chromosome 15 probe kit followed by DNA fragment analysis for methylation and copy number status. DNA extraction was successful in 30 of 34 PWS patients and 16 controls. PWS methylation testing was able to correctly identify all PWS patients and MS-MLPA was able to differentiate between 15q11-q13 deletion and non-deletion status and correctly identify deletion subtype (i.e., larger Type I or smaller Type II). mPCR can be used to diagnose PWS and MS-MLPA testing to determine both methylation status as well as the type of deletion or non-deletion status from DNA extracted from NBS filter paper. We propose that PWS testing in newborns is possible and could be included in the Recommended Uniform Screening Panel after establishing a validated cost-effective method.
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Affiliation(s)
- Ranim Mahmoud
- Department of Pediatrics, Division of Genetics and Metabolism, University of California, Irvine, California.,Faculty of Medicine, Department of Pediatrics, Genetics Unit, Mansoura University, Mansoura, Egypt
| | - Preeti Singh
- Department of Pediatrics, Division of Neonatology, University of California, Irvine, California
| | - Lan Weiss
- Department of Pediatrics, Division of Genetics and Metabolism, University of California, Irvine, California
| | - Anita Lakatos
- Department of Pediatrics, Division of Genetics and Metabolism, University of California, Irvine, California
| | - Melanie Oakes
- Genomics High Throughput Facility, University of California, Irvine, California
| | - Waheeda Hossain
- Department of Psychiatry and Behavioral Sciences, Kansas University Medical Center, Kansas City, Kansas.,Department of Pediatrics, Kansas University Medical Center, Kansas City, Kansas
| | - Merlin G Butler
- Department of Psychiatry and Behavioral Sciences, Kansas University Medical Center, Kansas City, Kansas.,Department of Pediatrics, Kansas University Medical Center, Kansas City, Kansas
| | - Virginia Kimonis
- Department of Pediatrics, Division of Genetics and Metabolism, University of California, Irvine, California
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12
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Çizmecioğlu FM, Jones JH, Paterson WF, Kherra S, Kourime M, McGowan R, Shaikh MG, Donaldson M. Neonatal Features of the Prader-Willi Syndrome; The Case for Making the Diagnosis During the First Week of Life. J Clin Res Pediatr Endocrinol 2018; 10:264-273. [PMID: 29553044 PMCID: PMC6083474 DOI: 10.4274/jcrpe.0029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE Early diagnosis is of proven benefit in Prader-Willi syndrome (PWS). We therefore examined key perinatal features to aid early recognition. METHODS Data were collected from case records of subjects attending a multi-disciplinary clinic and from a retrospective birth questionnaire. RESULTS Ninety patients (54 male-36 female) were seen between 1991-2015, most with paternal deletion (n=56) or maternal isodisomy (n=26). Features included cryptorchidism in 94% males, preterm birth (26%), birthweight <2500 g (24%), polyhydramnios (23%), breech presentation (23%) and need for nasogastric feeding (83%). Reduced fetal movements (FM) were reported in 82.5% patients compared with 4% healthy siblings. Of 35 children born since 1999, 23 were diagnosed clinically within 28 days while diagnosis in 12 was >28 days: 1-12 months in seven; and 3.75-10.5 years in five. Typical PWS features in these 12 infants included hypotonia (100%), feeding difficulties (75%), cryptorchidism (83% males) and reduced FM (66%). Causes other than PWS including neuromuscular disease were considered in nine patients. CONCLUSION Neonatal hypotonia, reduced FM, feeding difficulties and cryptorchidism should immediately suggest PWS, yet late diagnosis continues in some cases. Awareness of the typical features of PWS in newborn units is required to allow prompt detection even in the presence of confounding factors such as prematurity.
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Affiliation(s)
- Filiz Mine Çizmecioğlu
- Kocaeli University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Kocaeli, Turkey,* Address for Correspondence: Kocaeli University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Kocaeli, Turkey E-mail:
| | - Jeremy Huw Jones
- Royal Hospital for Children, Clinic of Endocrinology, Glasgow, United Kingdom
| | | | | | - Mariam Kourime
- University Hospital Abderrahim Harouchi, Casablanca, Morocco
| | - Ruth McGowan
- Southern Glasgow University Hospital, West of Scotland Genetic Services, Glasgow, United Kingdom
| | - M. Guftar Shaikh
- Royal Hospital for Children, Clinic of Endocrinology, Glasgow, United Kingdom
| | - Malcolm Donaldson
- University of Glasgow Faculty of Medicine, Royal Hospital for Children, Clinic of Child Health, Glasgow, United Kingdom
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13
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Bocchini S, Fintini D, Grugni G, Boiani A, Convertino A, Crinò A. Congenital hypothyroidism due to ectopic sublingual thyroid gland in Prader-Willi Syndrome: a case report. Ital J Pediatr 2017; 43:87. [PMID: 28938886 PMCID: PMC5610404 DOI: 10.1186/s13052-017-0403-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/11/2017] [Indexed: 01/25/2023] Open
Abstract
Background Thyroid gland disorders are variably associated with Prader-Willi syndrome (PWS). Many of the clinical features in newborns with PWS are similar to those found in congenital hypothyroidism (CH). Case presentation We report a case of a girl with CH and PWS. At the age of 9 months CH caused by an ectopic sublingual thyroid was diagnosed, and hormone replacement therapy was started. In spite of this treatment a decrease in growth velocity, weight excess and delayed development were observed. At the age of 9 years PWS was suspected on the basis of phenotype and genetic tests confirmed a maternal uniparental disomy of chromosome 15. This is the second reported case of hypothyroidism due to an ectopic sublingual thyroid gland in PWS suggesting that, although rare, an association between CH and PWS may exist. In our case diagnosis of PWS was delayed because mental retardation, hypotonia, obesity and short stature were initially attributed to hypothyroidism. Conclusions In this context PWS should be considered in obese children with CH who do not improve adequately with l-thyroxine therapy. Also, thyroid function in all PWS children should be assessed regularly in order to avoid delayed diagnosis of hypothyroidism.
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Affiliation(s)
- Sarah Bocchini
- Autoimmune Endocrine Diseases Unit, Bambino Gesù Children's Hospital, Research Institute, Palidoro, Rome, Italy
| | - Danilo Fintini
- Endocrinology and Diabetology Unit, Bambino Gesù Children's Hospital, Research Institute, Palidoro, Rome, Italy
| | - Graziano Grugni
- Division of Auxology, Italian Auxological Institute, Research Institute, Verbania, Piancavallo, Italy
| | - Arianna Boiani
- Autoimmune Endocrine Diseases Unit, Bambino Gesù Children's Hospital, Research Institute, Palidoro, Rome, Italy
| | - Alessio Convertino
- Autoimmune Endocrine Diseases Unit, Bambino Gesù Children's Hospital, Research Institute, Palidoro, Rome, Italy
| | - Antonino Crinò
- Autoimmune Endocrine Diseases Unit, Bambino Gesù Children's Hospital, Research Institute, Palidoro, Rome, Italy.
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14
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Bar C, Diene G, Molinas C, Bieth E, Casper C, Tauber M. Early diagnosis and care is achieved but should be improved in infants with Prader-Willi syndrome. Orphanet J Rare Dis 2017; 12:118. [PMID: 28659150 PMCID: PMC5490212 DOI: 10.1186/s13023-017-0673-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 06/14/2017] [Indexed: 11/21/2022] Open
Abstract
Background PWS is a severe neurodevelopmental genetic disorder now usually diagnosed in the neonatal period from hypotonia and feeding difficulties. Our study analyzed the birth incidence and care of infants with early diagnosis. Methods Data were collected on 61 infants with a molecular diagnosis of PWS born in 2012 and 2013 in France. Results Thirty-eight infants with PWS were born in 2013. The median age at diagnosis was 18 days. Birth incidence calculated for 2013 was 1/21,000 births. No case was diagnosed prenatally, despite 9 amniocenteses, including 4 for polyhydramnios. Five infants had delayed diagnosis, after 3 months of life. For 2 of them, the diagnosis was not suspected at birth and for 3, FISH analysis in the neonatal period was normal, with no further molecular studies. Ninety-three percent of the neonates were hospitalized, and 84% needed nasogastric tube feeding for a median of 38 days. Swallowing assessment was performed for 45%, at a median age of 10 days. Physiotherapy was started for 76% during hospitalization. Eighty percent of those diagnosed within the first 3 months were seen by a pediatric endocrinologist within the first week of life. Conclusion Our study is the first to assess the birth incidence of PWS in France, at 1/21,000 births. Some prenatal or neonatal cases remain undiagnosed because of unrecognized clinical signs and the inappropriate choice of the initial molecular test. We also underscore the need to optimize neonatal care of infants with PWS.
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Affiliation(s)
- Céline Bar
- Endocrinology, Obesity, Bone Diseases, Genetics and Gynecology Unit, Children's Hospital, University Hospital Center of Toulouse, 330, avenue de Grande-Bretagne, TSA 40031 - 31059, Toulouse cedex 9, France
| | - Gwenaelle Diene
- Endocrinology, Obesity, Bone Diseases, Genetics and Gynecology Unit, Children's Hospital, University Hospital Center of Toulouse, 330, avenue de Grande-Bretagne, TSA 40031 - 31059, Toulouse cedex 9, France.,National Reference Center of Prader-Willi Syndrome, Children's Hospital, University Hospital Center of Toulouse, 330, avenue de Grande-Bretagne, TSA 40031 - 31059, Toulouse cedex 9, France
| | - Catherine Molinas
- Endocrinology, Obesity, Bone Diseases, Genetics and Gynecology Unit, Children's Hospital, University Hospital Center of Toulouse, 330, avenue de Grande-Bretagne, TSA 40031 - 31059, Toulouse cedex 9, France.,National Reference Center of Prader-Willi Syndrome, Children's Hospital, University Hospital Center of Toulouse, 330, avenue de Grande-Bretagne, TSA 40031 - 31059, Toulouse cedex 9, France.,Centre de Physiopathologie de Toulouse-Purpan, Université de Toulouse, CNRS UMR 5282, INSERM UMR 1043, Paul Sabatier University, Toulouse, France
| | - Eric Bieth
- Genetics Unit, University Hospital Center of Toulouse, Toulouse, France.,Genetics Unit, Institut Fédératif de Biologie (IFB), 330, avenue de Grande-Bretagne, TSA 40031 - 31059, Toulouse cedex 9, France
| | - Charlotte Casper
- Neonatology Unit, Children's Hospital, University Hospital Center of Toulouse, 330, avenue de Grande-Bretagne, TSA 40031 - 31059, Toulouse cedex 9, France
| | - Maithé Tauber
- Endocrinology, Obesity, Bone Diseases, Genetics and Gynecology Unit, Children's Hospital, University Hospital Center of Toulouse, 330, avenue de Grande-Bretagne, TSA 40031 - 31059, Toulouse cedex 9, France. .,National Reference Center of Prader-Willi Syndrome, Children's Hospital, University Hospital Center of Toulouse, 330, avenue de Grande-Bretagne, TSA 40031 - 31059, Toulouse cedex 9, France. .,Centre de Physiopathologie de Toulouse-Purpan, Université de Toulouse, CNRS UMR 5282, INSERM UMR 1043, Paul Sabatier University, Toulouse, France.
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15
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Wang P, Zhou W, Yuan W, Huang L, Zhao N, Chen X. Prader-Willi syndrome in neonates: twenty cases and review of the literature in Southern China. BMC Pediatr 2016; 16:124. [PMID: 27506196 PMCID: PMC4977863 DOI: 10.1186/s12887-016-0662-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 08/02/2016] [Indexed: 12/23/2022] Open
Abstract
Background Prader-Willi syndrome is a rare genetic abnormality that can be challenging to diagnose early, but for which early interventions improve prognosis. Methods To improve understanding of Prader–Willi syndrome in neonates in Asia, we retrospectively analyzed the clinical records of 20 affected newborns diagnosed in the Department of Neonatology, Guangzhou Women and Children’s Medical Center, Guangzhou, China from January 2007 to December 2014 and performed a review of the relevant literature. Results Fourteen boys and six girls presented with hypotonia, poor responsiveness, feeding difficulty, and infrequent, weak crying. Different from western patients, the 20 Asian patients exhibited at least five of the following typical features: prominent forehead, narrow face, almond-shaped eyes, small mouth, downturned mouth, thin upper lip, and micromandible. All 14 boys had a small scrotum, including nine with cryptorchidism. Diagnoses were made with microarray comparative genomic hybridization. All 20 infants required feeding tubes. Fifteen received swallowing training immediately after admission; the period of continuous tube feeding for these patients ranged from 8 to 22 days (mean, 14 ± 5.3 days). For the five patients who did not receive swallowing training, the period of continuous tube feeding ranged from 15 to 35 days (mean, 18 ± 4.3 days). Comprehensive care measures included: giving parents detailed health education and basic information about this disease, teaching skills to promote feeding and prevent suffocation, increasing children’s passive activity, providing nutrition management for normal development, and preventing excessive or inadequate nutrient intake. Conclusions Neonates with Prader–Willi syndrome in Asia have hypotonia, poor responsiveness, feeding difficulty, infrequent and weak crying, genital hypoplasia, and characteristic facial features. Recognition of the syndrome in neonates with confirmation by genetic testing is essential, because early diagnosis allows early intervention. Treatment measures including swallowing training can improve prognosis, prevent growth retardation and obesity, and elevate quality of life in individuals with Prader–Willi syndrome.
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Affiliation(s)
- Ping Wang
- The First Affiliated Hospital of Jinan University, No 613, Huangpuda Road, Guangzhou, Guangdong, 510623, China.,Department of Neonatology, Guangzhou Women and Children's Medical Center, No 9, Jinsui Road, Guangzhou, Guangdong, 510623, China
| | - Wei Zhou
- Department of Neonatology, Guangzhou Women and Children's Medical Center, No 9, Jinsui Road, Guangzhou, Guangdong, 510623, China.
| | - Weiming Yuan
- Department of Neonatology, Guangzhou Women and Children's Medical Center, No 9, Jinsui Road, Guangzhou, Guangdong, 510623, China
| | - Longguang Huang
- Department of Neonatology, Guangzhou Women and Children's Medical Center, No 9, Jinsui Road, Guangzhou, Guangdong, 510623, China
| | - Ning Zhao
- Department of Neonatology, Guangzhou Women and Children's Medical Center, No 9, Jinsui Road, Guangzhou, Guangdong, 510623, China
| | - Xiaowen Chen
- Department of Neonatology, Guangzhou Women and Children's Medical Center, No 9, Jinsui Road, Guangzhou, Guangdong, 510623, China
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16
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Beauloye V, Diene G, Kuppens R, Zech F, Winandy C, Molinas C, Faye S, Kieffer I, Beckers D, Nergårdh R, Hauffa B, Derycke C, Delhanty P, Hokken-Koelega A, Tauber M. High unacylated ghrelin levels support the concept of anorexia in infants with prader-willi syndrome. Orphanet J Rare Dis 2016; 11:56. [PMID: 27146407 PMCID: PMC4855494 DOI: 10.1186/s13023-016-0440-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/27/2016] [Indexed: 12/14/2022] Open
Abstract
Background Prader-Willi syndrome (PWS) is a rare genetic neurodevelopmental disorder with different nutritional phases from suckling deficit with failure to thrive to early onset of obesity. Hyperghrelinemia has been described in PWS long before the development of obesity. Ghrelin is found in both acylated (AG) and unacylated (UAG) forms in the circulation. In contrast to AG, UAG has been shown to inhibit food intake and to be elevated in anorexia nervosa. The present project is aiming to determine the underlying mechanisms driving the different nutritional phases in PWS. Methods Measurement of at least 4 h-fasting plasma acylated and unacylated ghrelin in 37 infants with a genetic diagnosis of PWS aged from 1 month to 4 years and in 100 age-matched controls without endocrine disorder recruited prior to minor surgery. One blood sampling was analysed for each patient/control and clinical data were recorded. Eleven PWS infants underwent repetitive blood samples at 3 or 6-month intervals during routine visits. Results In infants with PWS, AG is not elevated (p = 0.45), UAG is significantly higher (p = 0.0044; confidence interval 1.06;1.33) resulting in a low AG/UAG ratio (p = 0.0056; confidence interval 0.76;0.95) compared to controls. Conclusion Unlike children and adults with PWS that have high AG and AG/UAG ratio, infants with PWS have elevated UAG that supports the concept of anorexia in the early phases of the disease. The change in AG/UAG ratio possibly drives the switch from failure to thrive to obesity. Clinical trial registration NCT02529085. Electronic supplementary material The online version of this article (doi:10.1186/s13023-016-0440-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Veronique Beauloye
- Unité d'Endocrinologie pédiatrique, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Avenue Hippocrate 10/1300, B-1200, Brussels, Belgium.
| | - Gwenaelle Diene
- Unité d'Endocrinologie, Obésité, Maladies Osseuses, Génétique et Gynécologie Médicale. Centre de Référence du Syndrome de Prader-Willi, Hôpital des Enfants, Toulouse, France
| | - Renske Kuppens
- Dutch Growth Research Foundation, Rotterdam, The Netherlands.,Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Francis Zech
- IREC, Université Catholique de Louvain, Brussels, Belgium
| | - Coralie Winandy
- Unité d'Endocrinologie pédiatrique, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Avenue Hippocrate 10/1300, B-1200, Brussels, Belgium
| | - Catherine Molinas
- Unité d'Endocrinologie, Obésité, Maladies Osseuses, Génétique et Gynécologie Médicale. Centre de Référence du Syndrome de Prader-Willi, Hôpital des Enfants, Toulouse, France.,Axe Pédiatrique du CIC 9302/INSERM. Hôpital des Enfants, Toulouse, France.,INSERM U1043, Centre de Physiopathologie de Toulouse Purpan, Université Paul Sabatier, Toulouse, France
| | - Sandy Faye
- Unité d'Endocrinologie, Obésité, Maladies Osseuses, Génétique et Gynécologie Médicale. Centre de Référence du Syndrome de Prader-Willi, Hôpital des Enfants, Toulouse, France.,Axe Pédiatrique du CIC 9302/INSERM. Hôpital des Enfants, Toulouse, France
| | - Isabelle Kieffer
- Unité d'Endocrinologie, Obésité, Maladies Osseuses, Génétique et Gynécologie Médicale. Centre de Référence du Syndrome de Prader-Willi, Hôpital des Enfants, Toulouse, France.,Axe Pédiatrique du CIC 9302/INSERM. Hôpital des Enfants, Toulouse, France
| | - Dominique Beckers
- Unité d'Endocrinologie Pédiatrique, CHU Dinant Godinne, Yvoir, Belgium
| | - Ricard Nergårdh
- Karolinska University Hospital, Karolinska Institutet, Solna, Sweden
| | - Berthold Hauffa
- Department of Endocrinology, University Children's Hospital, Essen, Germany
| | - Christine Derycke
- BESPEED (Belgian Society for Pediatric Endocrinology and Diabetology), Brussels, Belgium
| | - Patrick Delhanty
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Anita Hokken-Koelega
- Dutch Growth Research Foundation, Rotterdam, The Netherlands.,Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Maithé Tauber
- Unité d'Endocrinologie, Obésité, Maladies Osseuses, Génétique et Gynécologie Médicale. Centre de Référence du Syndrome de Prader-Willi, Hôpital des Enfants, Toulouse, France.,Axe Pédiatrique du CIC 9302/INSERM. Hôpital des Enfants, Toulouse, France.,INSERM U1043, Centre de Physiopathologie de Toulouse Purpan, Université Paul Sabatier, Toulouse, France.,Unité d'Endocrinologie, Hôpital des Enfants, 330, Avenue de Grande Bretagne, TSA 70034, 31059, Toulouse Cedex 9, France
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17
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Yang H, Zhang M, Song H, Zhu H, Pan H. Growth patterns of Chinese patients with Prader-Willi syndrome. Congenit Anom (Kyoto) 2015; 55:173-7. [PMID: 25900037 DOI: 10.1111/cga.12111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 04/14/2015] [Indexed: 11/28/2022]
Abstract
The aim of the present study was to investigate the spontaneous development of growth and weight gain of patients with Prader-Willi syndrome (PWS) in Mainland China. We retrospectively analyzed 120 cases of PWS diagnosed from 1994 to 2014 in Mainland China. Scatter diagram of the growth data was compared to standardized growth curve. The length at birth was similar to the normal population and the mean birthweight is under the 50th centile of normal population. Heights in 43% (27/62) of patients had dropped off below the 3(rd) centile of their peers after 5 years of age. Weights in 65.9% (58/88) of patients had exceeded the 97(th) centile of their peers after 3 years of age. Early obesity is obvious in 92.9% (66/71) of patients with body mass index (BMI) up the 97(th) centile of their peers from 2-3 years of age. Final mean height is 149.3 ± 11.2 cm for females (n = 7) and 146.2 ± 9.8 cm for males (n = 6), showing 11.3 cm and 26.6 cm below the average height for normal Chinese girls and boys. The growth pattern of PWS in Mainland China is comparable to those in Caucasians. Early intervention with recombinant human growth hormone is warranted considering the early onset of growth retardation and obesity.
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Affiliation(s)
- Hongbo Yang
- Key Laboratory of Endocrinology of the Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Beijing, China
| | - Mengqi Zhang
- Key Laboratory of Endocrinology of the Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Beijing, China
| | - Hongmei Song
- Department of Pediatrics, Peking Union Medical College Hospital, Beijing, China
| | - Huijuan Zhu
- Key Laboratory of Endocrinology of the Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Beijing, China
| | - Hui Pan
- Key Laboratory of Endocrinology of the Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Beijing, China
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18
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Highly restricted deletion of the SNORD116 region is implicated in Prader-Willi Syndrome. Eur J Hum Genet 2014; 23:252-5. [PMID: 24916642 DOI: 10.1038/ejhg.2014.103] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 03/27/2014] [Accepted: 04/04/2014] [Indexed: 02/02/2023] Open
Abstract
The SNORD116 locus lies in the 15q11-13 region of paternally expressed genes implicated in Prader-Willi Syndrome (PWS), a complex disease accompanied by obesity and severe neurobehavioural disturbances. Cases of PWS patients with a deletion encompassing the SNORD116 gene cluster, but preserving the expression of flanking genes, have been described. We report a 23-year-old woman who presented clinical criteria of PWS, including the behavioural and nutritional features, obesity, developmental delay and endocrine dysfunctions with hyperghrelinemia. We found a paternally transmitted highly restricted deletion of the SNORD116 gene cluster, the shortest described to date (118 kb). This deletion was also present in the father. This finding in a human case strongly supports the current hypothesis that lack of the paternal SNORD116 gene cluster has a determinant role in the pathogenesis of PWS. Moreover, targeted analysis of the SNORD116 gene cluster, complementary to SNRPN methylation analysis, should be carried out in subjects with a phenotype suggestive of PWS.
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19
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Sharkia M, Michaud S, Berthier MT, Giguère Y, Stewart L, Deladoëy J, Deal C, Van Vliet G, Chanoine JP. Thyroid function from birth to adolescence in Prader-Willi syndrome. J Pediatr 2013; 163:800-5. [PMID: 23623517 DOI: 10.1016/j.jpeds.2013.03.058] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 02/20/2013] [Accepted: 03/20/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To describe the response of thyroid-stimulating hormone (TSH) to thyroid-releasing hormone in children and adolescents with Prader-Willi syndrome (PWS), and to compare TSH and total thyroxine (TT4) concentrations measured on neonatal screening for congenital hypothyroidism in children with PWS and controls. STUDY DESIGN All participants had genetically confirmed PWS. The TSH responses to thyroid-releasing hormone, free thyroxine (fT4), and free triiodothyronine (fT3) were measured in 21 subjects (14 females and 7 males; mean age, 6.4 years). Capillary TT4 was measured on neonatal screening samples from 23 subjects with PWS (14 females and 9 males), each of whom was matched for birth weight and sex with 4 anonymized controls. RESULTS One subject with PWS had tertiary hypothyroidism. TSH level increased from 1.37 mU/L at baseline to 39.6 mU/L at 20 minutes, 47.2 mU/L at 40 minutes, 44.5 mU/L at 60 minutes, and 47.2 mU/L at 120 minutes. fT4 concentration was 6.3 pmol/L, and fT3 concentration was 4.6 pmol/L. In the other 20 subjects, mean TSH level was 1.9 mU/L (range, 0.8-4.2 mU/L) at baseline and 21.8 mU/L (range, 10.0-46.7 mU/L) at 20 minutes (peak). Mean fT4 concentration (10.4 pmol/L; range, 8.2-13.5 pmol/L) was in the lower one-third of the normal range in 18 subjects, and mean fT3 concentration (6.1 pmol/L; range, 4.8-8.4 pmol/L) was above the median in 13 subjects. In neonates, mean TSH level was 3.1 mU/L (range, 0.4-10.0 mU/L) in subjects with PWS versus 3.3 mU/L (range, 0.0-7.0 mU/L) in controls, and mean TT4 in subjects with PWS was 111% (range, 17%-203%) that of controls (P = not significant). CONCLUSION Thyroid function was normal in our newborn subjects. In older children, frank hypothyroidism was found in only 1 of our 21 subjects. Thus, levothyroxine treatment should not be routinely prescribed to youth with PWS.
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Affiliation(s)
- Mohamad Sharkia
- Endocrinology and Diabetes Unit, British Columbia's Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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20
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Abstract
Prader-Willi syndrome (PWS) is a multifaceted developmental disorder most commonly associated with extreme hyperphagia and life-threatening obesity. PWS is a genetic disorder of imprinting with almost all cases occurring spontaneously. Behavioural and imaging studies have shown that obesity in PWS arises from overeating driven by a faulty satiety mechanism which manifests as an almost permanent state similar to starvation. With no available treatments, management of the eating behaviour is the only option and has two main strategies: restrict access to food and distract thoughts from food. In this mini review, which we have aimed at clinicians, we outline the main aspects of PWS including genetics, development of the eating behaviour and best practice approaches to management.
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Affiliation(s)
- C J McAllister
- Cambridge Intellectual and Developmental Disabilities Research Group, Department of Psychiatry, University of Cambridge, Cambridge, UK
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21
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Jin DK. Systematic review of the clinical and genetic aspects of Prader-Willi syndrome. KOREAN JOURNAL OF PEDIATRICS 2011; 54:55-63. [PMID: 21503198 PMCID: PMC3077502 DOI: 10.3345/kjp.2011.54.2.55] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 01/31/2011] [Indexed: 01/20/2023]
Abstract
Prader-Willi syndrome (PWS) is a complex multisystem genetic disorder that is caused by the lack of expression of paternally inherited imprinted genes on chromosome 15q11-q13. This syndrome has a characteristic phenotype including severe neonatal hypotonia, early-onset hyperphagia, development of morbid obesity, short stature, hypogonadism, learning disabilities, behavioral problems, and psychiatric problems. PWS is an example of a genetic condition caused by genomic imprinting. It can occur via 3 main mechanisms that lead to the absence of expression of paternally inherited genes in the 15q11.2-q13 region: paternal microdeletion, maternal uniparental disomy, and an imprinting defect. Over 99% of PWS cases can be diagnosed using DNA methylation analysis. Early diagnosis of PWS is important for effective long-term management. Growth hormone (GH) treatment improves the growth, physical phenotype, and body composition of patients with PWS. In recent years, GH treatment in infants has been shown to have beneficial effects on the growth and neurological development of patients diagnosed during infancy. There is a clear need for an integrated multidisciplinary approach to facilitate early diagnosis and optimize management to improve quality of life, prevent complications, and prolong life expectancy in patients with PWS.
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Affiliation(s)
- Dong Kyu Jin
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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22
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PET scan perfusion imaging in the Prader-Willi syndrome: new insights into the psychiatric and social disturbances. J Cereb Blood Flow Metab 2011; 31:275-82. [PMID: 20588317 PMCID: PMC3049491 DOI: 10.1038/jcbfm.2010.87] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Prader-Willi syndrome (PWS), a rare multisystem genetic disease, leads to severe disabilities, such as morbid obesity, endocrine dysfunctions, psychiatric disorders, and social disturbances. We explored the whole brain of patients with PWS to detect abnormalities that might explain the behavioral and social disturbances, as well as the psychiatric disorders of these patients. Nine patients with PWS (six males, three females; mean age 16.4 years) underwent a positron emission tomography (PET) scan with H(2)(15)O as a tracer to measure regional cerebral blood flow (rCBF). The images were compared with those acquired from nine controls (six males, three females; mean age 21.2 years). A morphologic magnetic resonance imaging (MRI) was also performed in PWS patients, and their cognitive and behavioral skills were assessed with Wechsler Intelligence Scale for Children III and the Child Behavior Check List (CBCL). The MRI images showed no evident anatomic abnormalities, whereas PET scans revealed hypoperfused brain regions in PWS patients compared with controls, particularly in the anterior cingulum and superior temporal regions. We observed a significant relationship (P<0.05) between rCBF in the hypoperfused regions and CBCL scores. The functional consequences of these perfusion abnormalities in specific brain regions might explain the behavioral and social problems observed in these individuals.
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Zhang YW, Jia HY, Hong J, Ge Y, Zhang HJ, Shen CF, Ye L, Cui B, Li XY, Gu WQ, Zhang YF, Wang WQ, Ning G. Clinical and genetic analysis for four Chinese families with Prader-Willi syndrome. Endocrine 2009; 36:37-44. [PMID: 19421899 DOI: 10.1007/s12020-009-9203-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 03/23/2009] [Accepted: 04/09/2009] [Indexed: 10/20/2022]
Abstract
Prader-Willi syndrome (PWS) is a complex, genetic, multisystem disorder. Its major clinical features include neonatal hypotonia and failure to thrive, mental retardation, hypogonadism, short hands and feet, hyperphagia-caused obesity, and characteristic appearance. The genetic basis of PWS is also complex. It is caused by the absence of expression of the active paternal genes such as the SNRPN, NDN, and possibly others in the PWS critical region on 15q11-13. PWS is in effect a contiguous gene syndrome resulting from deletion of the paternal copies of the imprinted. Consensus in clinical diagnostic criteria was established in 1993. However, identifying relevant patients for tests remains a challenge for most practitioners, as many features of the disorder are nonspecific, and others can be subtle or evolved over time. Consequently, molecular genetic tests can be used to diagnose PWS accurately, allowing early diagnosis of the syndrome. High resolution G-banding, high resolution cytogenetic methylation-specific PCR (MS-PCR), and fluorescence in situ hybridization (FISH) are routinely used to diagnose PWS. In this study, four Chinese patients, with typical PWS features, were detected by MS-PCR and FISH. Three were cytogenetically normal, but lacked paternal expression of proximal chromosome 15q because of maternal uniparental disomy (UPD). The other one, however, demonstrated an unbalanced de novo translocation 46, XX, t (7; 15).
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Affiliation(s)
- Yu-wen Zhang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China
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24
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Breathing deficits of the Prader-Willi syndrome. Respir Physiol Neurobiol 2009; 168:119-24. [DOI: 10.1016/j.resp.2009.03.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Revised: 03/21/2009] [Accepted: 03/21/2009] [Indexed: 11/18/2022]
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25
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Weiss HR, Goodall D. Scoliosis in patients with Prader Willi Syndrome - comparisons of conservative and surgical treatment. SCOLIOSIS 2009; 4:10. [PMID: 19419581 PMCID: PMC2690578 DOI: 10.1186/1748-7161-4-10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 05/06/2009] [Indexed: 11/10/2022]
Abstract
UNLABELLED In children with Prader Willi syndrome (PWS), besides growth hormone (GH) therapy, control of the food environment and regular exercise, surgical treatment of scoliosis deformities seems the treatment of choice, even though the risks of spinal surgery in this specific population is very high. Therefore the question arises as to whether the risks of spinal surgery outweigh the benefits in a condition, which bears significant risks per se. The purpose of this systematic review of the Pub Med literature was to find mid or long-term results of spinal fusion surgery in patients with PWS, and to present the conservative treatment in a case study of nine patients with this condition. METHODS Types of studies included; all kinds of studies; retrospective and prospective ones, which reported upon the outcome of scoliosis surgery in patients with PWS.Types of participants included: patients with scoliosis and PWS.Type of intervention: surgery.Search strategy for identification of the studies; Pub Med; limited to English language and bibliographies of all reviewed articles.Nine patients with PWS from our data-base treated conservatively have been found, being 19 years or over at the time this study has been performed. The results of conservative management are described and related to the natural history and treatment results found in the Pub Med review. RESULTS From 2210 titles displayed in the Pub Med database with the key word being "Prader Willi syndrome", 5 different papers were displayed at the date of the search containing some information on the outcome of surgery and none appeared to contain a mid or long-term follow-up. The PWS patients treated conservatively from our series all stayed below 70 degrees and some of which improved. DISCUSSION If the curve of scoliosis patients with PWS can be kept within certain limits (usually below 70 degrees) conservatively, this treatment seems to have fewer complications than surgical treatments. The results of our retrospective study of nine patients demonstrate that scoliosis in this entity plays only a minor role and surgery is unnecessary when high quality conservative management exists. CONCLUSION There is lack of the long follow-up studies in post-surgical cases in patients with PWS and scoliosis. The rate of complications of spinal fusion in patients with PWS and scoliosis is very high and the death rates have been found to be higher than in patients with Adolescent Idiopathic Scoliosis (AIS). The long-term side-effects of the intervention are detrimental, so that the risk-benefit ratio favours the conservative approaches over spinal fusion surgery.
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26
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Molinas C, Cazals L, Diene G, Glattard M, Arnaud C, Tauber M. French database of children and adolescents with Prader-Willi syndrome. BMC MEDICAL GENETICS 2008; 9:89. [PMID: 18831731 PMCID: PMC2569911 DOI: 10.1186/1471-2350-9-89] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/05/2008] [Accepted: 10/02/2008] [Indexed: 01/08/2023]
Abstract
Background Prader-Willi syndrome (PWS) is a rare multisystem genetic disease leading to severe complications mainly related to obesity. We strongly lack information on the natural history of this complex disease and on what factors are involved in its evolution and its outcome. One of the objectives of the French reference centre for Prader-Willi syndrome set-up in 2004 was to set-up a database in order to make the inventory of Prader-Willi syndrome cases and initiate a national cohort study in the area covered by the centre. Description the database includes medical data of children and adolescents with Prader-Willi syndrome, details about their management, socio-demographic data on their families, psychological data and quality of life of the parents. The tools and organisation used to ensure data collection and data quality in respect of good clinical practice procedures are discussed, and main characteristics of our Prader-Willi population at inclusion are presented. Conclusion this database covering all the aspects of PWS clinical, psychological and social profiles, including familial psychological and quality of life will be a powerful tool for retrospective studies concerning this complex and multi factorial disease and could be a basis for the design of future prospective multicentric studies. The complete database and the Stata.do files are available to any researcher wishing to use them for non-commercial purposes and can be provided upon request to the corresponding author.
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Affiliation(s)
- Catherine Molinas
- Centre de Référence du syndrome de Prader-Willi, Division of Endocrinology, Genetics, Gynaecology and Bone Diseases, Hôpital des Enfants, and University Paul Sabatier, Toulouse, France.
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27
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Odent T, Accadbled F, Koureas G, Cournot M, Moine A, Diene G, Molinas C, Pinto G, Tauber M, Gomes B, de Gauzy JS, Glorion C. Scoliosis in patients with Prader-Willi Syndrome. Pediatrics 2008; 122:e499-503. [PMID: 18606625 DOI: 10.1542/peds.2007-3487] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Our goals were to determine the prevalence and estimate the evolution of spinal deformities in patients suffering from Prader-Willi syndrome; find out which kind of spine deformity predominates regarding genotype and clinical patterns; and evaluate the affect of growth-hormone treatment on the onset and progression of spinal deformities. PATIENTS AND METHODS This was a retrospective longitudinal, clinical, and radiologic study. One hundred forty-five children followed between 1980 and 2006 were studied in 2 referral centers for Prader-Willi syndrome. Genetic testing confirmed the diagnosis in 133 patients. Ninety-three patients (64%) received growth-hormone therapy. For statistical analysis, age-adjusted comparison between groups was performed by using multivariate logistic regression. RESULTS Mean age of the patients was 10.2 +/- 6.2 years. Sixty-three (43.4%) patients were afflicted with scoliosis. Scoliosis frequency steadily rose with age, and a large majority of patients were affected at skeletal maturity (66.7%). Scoliosis prevalence was not affected by the genotype or by growth-hormone treatment. Patients with higher BMI values had an increased risk of developing a kyphotic deformity in association with scoliosis. We found a statistical association between kyphotic deformity and the need for surgical treatment. CONCLUSIONS Scoliosis is a major concern for patients with Prader-Willi syndrome, and a regular (annual) systematic back examination is mandated. The role of growth-hormone treatment on the natural history of scoliosis could not be determined, and careful monitoring during treatment is recommended.
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Affiliation(s)
- Thierry Odent
- Department of Orthopaedic Surgery, Hôpital des Enfants-Malades Assistance-Publique Hôpitaux de Paris, Faculté de Médicine Paris Descartes, Paris, France.
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