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Kim SW, Kim B, Kim Y, Lee KA. Re-evaluation of a Fibrillin-1 Gene Variant of Uncertain Significance Using the ClinGen Guidelines. Ann Lab Med 2024; 44:271-278. [PMID: 37840311 PMCID: PMC10813823 DOI: 10.3343/alm.2023.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/25/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Background Marfan syndrome (MFS) is caused by fibrillin-1 gene (FBN1) variants. Mutational hotspots and/or well-established critical functional domains of FBN1 include cysteine residues, calcium-binding consensus sequences, and amino acids related to interdomain packaging. Previous guidelines for variant interpretation do not reflect the features of genes or related diseases. Using the Clinical Genome Resource (ClinGen) FBN1 variant curation expert panel (VCEP), we re-evaluated FBN1 germline variants reported as variants of uncertain significance (VUSs). Methods We re-evaluated 26 VUSs in FBN1 reported in 161 patients with MFS. We checked the variants in the Human Genome Mutation Database, ClinVar, and VarSome databases and assessed their allele frequencies using the gnomAD database. Patients' clinical information was reviewed. Results Four missense variants affecting cysteines (c.460T>C, c.1006T>C, c.5330G>C, and c.8020T>C) were reclassified as likely pathogenic and were assigned PM1_strong or PM1. Two intronic variants were reclassified as benign by granting BA1 (stand-alone). Four missense variants were reclassified as likely benign. BP5 criteria were applied in cases with an alternate molecular basis for disease, one of which (c.7231G>A) was discovered alongside a pathogenic de novo COL3A1 variant (c.1988G>T, p.Gly633Val). Conclusions Considering the high penetrance of FBN1 variants and clinical variability of MFS, the detection of pathogenic variants is important. The ClinGen FBN1 VCEP encompasses mutational hotspots and/or well-established critical functional domains and adjusts the criteria specifically for MFS; therefore, it is beneficial not only for identifying pathogenic FBN1 variants but also for distinguishing these variants from those that cause other connective tissue disorders with overlapping clinical features.
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Affiliation(s)
- Seo Wan Kim
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Boyeon Kim
- Department of Laboratory Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yoonjung Kim
- Department of Laboratory Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung-A Lee
- Department of Laboratory Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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2
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Shen Y, Liu Q, Li H, Liu W, Hu H, Zhao Y, Li Y, Chen Y, Liu S, Yu Q, Zhuang H, Wu L, Hu Z, Zheng Z, Shen J, Lin S, Shen Y, Zhou Y, Ye B, Wu D. Whole-exome sequencing identifies FANC heterozygous germline mutation as an adverse factor for immunosuppressive therapy in Chinese aplastic anemia patients aged 40 or younger: a single-center retrospective study. Ann Hematol 2023; 102:503-517. [PMID: 36622392 PMCID: PMC9977704 DOI: 10.1007/s00277-023-05086-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 12/31/2022] [Indexed: 01/10/2023]
Abstract
Acquired aplastic anemia (AA) is a bone marrow failure disorder characterized by pancytopenia, and immunosuppressive therapy (IST) is the optional first-line management. Several studies identified the influencing factors on IST response; however, there are still a considerable number of patients suffering from poor prognoses. In this study, we enrolled 61 AA patients aged ≤ 40 years old, and whole-exome sequencing (WES) found unexpected high FANC heterozygous germline mutations (28/61, 45.9%). Patients with FANC mutations have a significantly lower absolute reticulocyte count and CD34+ % in the bone marrow and also lower 3-, 6-, and 9-month IST response than that without mutation, which were 0% vs. 25% (P = 0.017), 26.3% vs. 42.1% (P = 0.495), and 29.4% vs. 72.2% (P = 0.011), especially in anti-thymocyte globulin combined with the cyclosporin A (ATG + CsA) group, which were 0% vs.33.4% (P = 0.143), 25% vs.83.3% (P = 0.103), and 25% vs. 100% (P = 0.003), respectively. The event-free survival in the FANCwt group was also better than that in the FANCmut group (P = 0.016) and also showed in patients who received ATG + CsA treatment (P = 0.045). In addition, all the adverse effects of FANC germline mutation were not significant in stem cell-transplanted group. Our result indicated that the WES-based detection of FANC heterozygous germline mutations may have a great meaning in predicting IST response of acquired AA. This study was registered at chictr.org.cn (# ChiCTR2100054992).
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Affiliation(s)
- Yingying Shen
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, #54 Youdian Road, Hangzhou, 310006, Zhejiang, China
- National TCM Clinical Research Base (Hematology), Hangzhou, Zhejiang, China
| | - Qi Liu
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Hangchao Li
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, #54 Youdian Road, Hangzhou, 310006, Zhejiang, China
- National TCM Clinical Research Base (Hematology), Hangzhou, Zhejiang, China
| | - Wenbin Liu
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, #54 Youdian Road, Hangzhou, 310006, Zhejiang, China
- National TCM Clinical Research Base (Hematology), Hangzhou, Zhejiang, China
| | - Huijin Hu
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, #54 Youdian Road, Hangzhou, 310006, Zhejiang, China
- National TCM Clinical Research Base (Hematology), Hangzhou, Zhejiang, China
| | - Yuechao Zhao
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, #54 Youdian Road, Hangzhou, 310006, Zhejiang, China
- National TCM Clinical Research Base (Hematology), Hangzhou, Zhejiang, China
| | - Yuzhu Li
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Ying Chen
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, #54 Youdian Road, Hangzhou, 310006, Zhejiang, China
- National TCM Clinical Research Base (Hematology), Hangzhou, Zhejiang, China
| | - Shan Liu
- National TCM Clinical Research Base (Hematology), Hangzhou, Zhejiang, China
- Department of Clinical Evaluation Center, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Qinghong Yu
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, #54 Youdian Road, Hangzhou, 310006, Zhejiang, China
- National TCM Clinical Research Base (Hematology), Hangzhou, Zhejiang, China
| | - Haifeng Zhuang
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, #54 Youdian Road, Hangzhou, 310006, Zhejiang, China
- National TCM Clinical Research Base (Hematology), Hangzhou, Zhejiang, China
| | - Liqiang Wu
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, #54 Youdian Road, Hangzhou, 310006, Zhejiang, China
- National TCM Clinical Research Base (Hematology), Hangzhou, Zhejiang, China
| | - Zhiping Hu
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, #54 Youdian Road, Hangzhou, 310006, Zhejiang, China
- National TCM Clinical Research Base (Hematology), Hangzhou, Zhejiang, China
| | - Zhiyin Zheng
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, #54 Youdian Road, Hangzhou, 310006, Zhejiang, China
- National TCM Clinical Research Base (Hematology), Hangzhou, Zhejiang, China
| | - Jianping Shen
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, #54 Youdian Road, Hangzhou, 310006, Zhejiang, China
- National TCM Clinical Research Base (Hematology), Hangzhou, Zhejiang, China
| | - Shenyun Lin
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, #54 Youdian Road, Hangzhou, 310006, Zhejiang, China
- National TCM Clinical Research Base (Hematology), Hangzhou, Zhejiang, China
| | - Yiping Shen
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, #54 Youdian Road, Hangzhou, 310006, Zhejiang, China
- National TCM Clinical Research Base (Hematology), Hangzhou, Zhejiang, China
| | - Yuhong Zhou
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, #54 Youdian Road, Hangzhou, 310006, Zhejiang, China
- National TCM Clinical Research Base (Hematology), Hangzhou, Zhejiang, China
| | - Baodong Ye
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, #54 Youdian Road, Hangzhou, 310006, Zhejiang, China.
- National TCM Clinical Research Base (Hematology), Hangzhou, Zhejiang, China.
| | - Dijiong Wu
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, #54 Youdian Road, Hangzhou, 310006, Zhejiang, China.
- National TCM Clinical Research Base (Hematology), Hangzhou, Zhejiang, China.
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Brandariz RN, Abrego MO, Boretto JG, Gallucci GL, Carli PD. Atraumatic Bilateral Instability of Ulnar Nerve and Extensor Carpi Ulnaris in a Patient with Marfan's Syndrome. J Orthop Case Rep 2019; 9:3-6. [PMID: 32547992 PMCID: PMC7276630 DOI: 10.13107/jocr.2019.v09.i05.1506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Marfan’s syndrome is a hereditary, autosomal dominant multisystemic disorder involving connective tissue. Bilateral extensor carpi ulnaris and ulnar nerve (UN) instability is rare, usually caused by the alteration of structures mainly formed by connective tissue. The association between Marfan’s syndrome and bilateral instability of UN and extensor carpi ulnaris has never been reported. Case Report: We present the case of a 38-year-old female with no history of trauma, diagnosed with Marfan’s syndrome, who developed bilateralinstability of the UN and extensor carpi ulnaris. Bilateral UN transposition and extensor carpi ulnaris tenoplasty were performed. Conclusion: Atraumatic bilateral instability of UN and extensor carpi ulnaris is a new rare clinical profile caused by Marfan’s syndrome whether standard treatment is successful in a long-term basis in these particular cases of collagen intrinsic pathology remains unclear.
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Affiliation(s)
- R N Brandariz
- Department of Trauma and Orthopaedics "Carlos E. Ottolenghi," Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - M O Abrego
- Department of Trauma and Orthopaedics "Carlos E. Ottolenghi," Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - J G Boretto
- Department of Trauma and Orthopaedics "Carlos E. Ottolenghi," Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - G L Gallucci
- Department of Trauma and Orthopaedics "Carlos E. Ottolenghi," Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - P De Carli
- Department of Trauma and Orthopaedics "Carlos E. Ottolenghi," Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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4
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Morgan TM. Genomic Screening: The Mutation and the Mustard Seed. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2018; 46:541-546. [PMID: 30146977 PMCID: PMC9547665 DOI: 10.1177/1073110518782963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Thomas M Morgan
- Thomas M. Morgan, M.D., F.A.C.M.G., is an Associate Professor of Pediatrics at Vanderbilt University School of Medicine
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5
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Wang Y, Chen S, Wang R, Huang S, Yang M, Liu L, Liu Q. Postmortem diagnosis of Marfan syndrome in a case of sudden death due to aortic rupture: Detection of a novel FBN1 frameshift mutation. Forensic Sci Int 2017; 261:e1-4. [PMID: 26905825 DOI: 10.1016/j.forsciint.2016.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/04/2016] [Accepted: 02/07/2016] [Indexed: 11/30/2022]
Abstract
To investigate the sudden death of a 36-year-old Chinese man, a medicolegal autopsy was performed, combining forensic pathological examinations and genetic sequencing analysis to diagnose the cause of death. Genomic DNA samples were extracted from blood and subjected to high-throughput sequencing. Major findings included a dilated aortic root with a ruptured and dissected aorta and consequent tamponade of the pericardial sac. Moreover, arachnodactyly and other skeletal deformities were noted. By sequencing the fibrillin-1 gene (FBN1), five genetic variations were found, including four previously known single nucleotide polymorphisms (SNPs) and a novel frameshift mutation, leading to the diagnosis of Marfan syndrome. The frameshift mutation (c.4921delG, p.glu1641llysFsX9) detected in exon 40 led to a stop codon after the next 8 amino acids. The four SNPs included a splice site mutation (c.3464-5 G>A, rs11853943), a synonymous mutation (p.Asn625Asn, rs25458), and two missense mutations (p.Pro1148Ala, rs140598; p.Cys472Tyr, rs4775765). Genetic screening was recommended for the relatives as it was reported that the father and brother of the deceased had died at the ages of 40 and 25, respectively, from sudden cardiac failure. The son of the deceased lacked the relevant mutations. This report emphasizes the important contribution of medicolegal postmortem analysis on the molecular pathogenesis study of Marfan syndrome and early diagnosis of at-risk relatives.
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Affiliation(s)
- Yunyun Wang
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Shu Chen
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Rongshuai Wang
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Sizhe Huang
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Mingzhen Yang
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Liang Liu
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Key Laboratory of Evidence Science, China University of Political Science and Law, Ministry of Education, Beijing 100040, China
| | - Qian Liu
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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6
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Pinard A, Salgado D, Desvignes JP, Rai G, Hanna N, Arnaud P, Guien C, Martinez M, Faivre L, Jondeau G, Boileau C, Zaffran S, Béroud C, Collod-Béroud G. WES/WGS Reporting of Mutations from Cardiovascular "Actionable" Genes in Clinical Practice: A Key Role for UMD Knowledgebases in the Era of Big Databases. Hum Mutat 2016; 37:1308-1317. [PMID: 27647783 DOI: 10.1002/humu.23119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/22/2016] [Accepted: 09/12/2016] [Indexed: 12/27/2022]
Abstract
High-throughput next-generation sequencing such as whole-exome and whole-genome sequencing are being rapidly integrated into clinical practice. The use of these techniques leads to the identification of secondary variants for which decisions about the reporting or not to the patient need to be made. The American College of Medical Genetics and Genomics recently published recommendations for the reporting of these variants in clinical practice for 56 "actionable" genes. Among these, seven are involved in Marfan Syndrome And Related Disorders (MSARD) resulting from mutations of the FBN1, TGFBR1 and 2, ACTA2, SMAD3, MYH11 and MYLK genes. Here, we show that mutations collected in UMD databases for MSARD genes (UMD-MSARD) are rarely reported, including the most frequent ones, in global scale initiatives for variant annotation such as the NHLBI GO Exome Sequencing Project (ESP), the Exome Aggregation Consortium (ExAC), and ClinVar. The predicted pathogenic mutations reported in global scale initiatives but absent in locus-specific databases (LSDBs) mainly correspond to rare events. UMD-MSARD databases are therefore the only resources providing access to the full spectrum of known pathogenic mutations. They are the most comprehensive resources for clinicians and geneticists to interpret MSARD-related variations not only primary variants but also secondary variants.
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Affiliation(s)
| | | | | | - Ghadi Rai
- Aix Marseille Univ, INSERM, GMGF, Marseille, France
| | - Nadine Hanna
- Département de Génétique, Hôpital Bichat AP-HP, Paris, France.,Inserm U1148 LVTS, Equipe 2 Maladies Structurelles Cardiovasculaires, Hôpital Bichat, Université Paris Diderot, Sorbonne Paris Cité.,Centre National de Référence Maladies Rares, Syndrome de Marfan et pathologies apparentées, Hôpital Bichat, AP-HP, Paris, France
| | - Pauline Arnaud
- Département de Génétique, Hôpital Bichat AP-HP, Paris, France.,Inserm U1148 LVTS, Equipe 2 Maladies Structurelles Cardiovasculaires, Hôpital Bichat, Université Paris Diderot, Sorbonne Paris Cité.,Centre National de Référence Maladies Rares, Syndrome de Marfan et pathologies apparentées, Hôpital Bichat, AP-HP, Paris, France
| | - Céline Guien
- Aix Marseille Univ, INSERM, GMGF, Marseille, France
| | - Maria Martinez
- IRSD, INSERM, INRA, ENVT, UPS, Université de Toulouse, Toulouse, France
| | - Laurence Faivre
- Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement (TRANSLAD), Centre Hospitalier Universitaire Dijon, Dijon, France.,Centre de Génétique et Centre de Référence, Anomalies du Développement et Syndromes Malformatifs de l'Inter-région Est, Centre Hospitalier Universitaire Dijon, Dijon, France.,EA 4271 GAD, Université de Bourgogne Franche-Comté, Dijon, France
| | - Guillaume Jondeau
- Centre National de Référence Maladies Rares, Syndrome de Marfan et pathologies apparentées, Hôpital Bichat, AP-HP, Paris, France.,Service de Cardiologie, AP-HP, Hôpital Bichat, Paris, France.,AP-HP, Centre de référence pour les syndromes de Marfan et apparentés, Service de Cardiologie, Hôpital Bichat, Paris, France
| | - Catherine Boileau
- Inserm U1148 LVTS, Equipe 2 Maladies Structurelles Cardiovasculaires, Hôpital Bichat, Université Paris Diderot, Sorbonne Paris Cité.,Centre National de Référence Maladies Rares, Syndrome de Marfan et pathologies apparentées, Hôpital Bichat, AP-HP, Paris, France.,AP-HP, Centre de référence pour les syndromes de Marfan et apparentés, Service de Cardiologie, Hôpital Bichat, Paris, France
| | | | - Christophe Béroud
- Aix Marseille Univ, INSERM, GMGF, Marseille, France.,AP-HM, Département de Génétique Médicale, Hôpital Timone Enfants, Marseille, France
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7
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Sampson MG, Gillies CE, Robertson CC, Crawford B, Vega-Warner V, Otto EA, Kretzler M, Kang HM. Using Population Genetics to Interrogate the Monogenic Nephrotic Syndrome Diagnosis in a Case Cohort. J Am Soc Nephrol 2016; 27:1970-83. [PMID: 26534921 PMCID: PMC4926977 DOI: 10.1681/asn.2015050504] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 09/06/2015] [Indexed: 01/02/2023] Open
Abstract
To maximize clinical benefits of genetic screening of patients with nephrotic syndrome (NS) to diagnose monogenic causes, reliably distinguishing NS-causing variants from the background of rare, noncausal variants prevalent in all genomes is vital. To determine the prevalence of monogenic NS in a North American case cohort while accounting for background prevalence of genetic variation, we sequenced 21 implicated monogenic NS genes in 312 participants from the Nephrotic Syndrome Study Network and 61 putative controls from the 1000 Genomes Project (1000G). These analyses were extended to available sequence data from approximately 2500 subjects from the 1000G. A typical pathogenicity filter identified causal variants for NS in 4.2% of patients and 5.8% of subjects from the 1000G. We devised a more stringent pathogenicity filtering strategy, reducing background prevalence of causal variants to 1.5%. When applying this stringent filter to patients, prevalence of monogenic NS was 2.9%; of these patients, 67% were pediatric, and 44% had FSGS on biopsy. The rate of complete remission did not associate with monogenic classification. Thus, we identified factors contributing to inaccurate monogenic classification of NS and developed a more accurate variant filtering strategy. The prevalence and clinical correlates of monogenic NS in this sporadically affected cohort differ substantially from those reported for patients referred for genetic analysis. Particularly in unselected, population-based cases, considering putative causal variants in known NS genes from a probabilistic rather than a deterministic perspective may be more precise. We also introduce GeneVetter, a web tool for monogenic assessment of rare disease.
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Affiliation(s)
| | | | | | | | | | - Edgar A Otto
- Departments of Pediatrics and Communicable Diseases, and
| | - Matthias Kretzler
- Internal Medicine, Division of Nephrology and Department of Computational Medicine and Bioinformatics, University of Michigan School of Medicine, Ann Arbor, Michigan; and
| | - Hyun Min Kang
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
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9
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Reyes-Hernández OD, Palacios-Reyes C, Chávez-Ocaña S, Cortés-Malagón EM, Alonso-Themann PG, Ramos-Cano V, Ramírez-Bello J, Sierra-Martínez M. Skeletal manifestations of Marfan syndrome associated to heterozygous R2726W FBN1 variant: sibling case report and literature review. BMC Musculoskelet Disord 2016; 17:79. [PMID: 26875674 PMCID: PMC4753669 DOI: 10.1186/s12891-016-0935-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 02/06/2016] [Indexed: 11/16/2022] Open
Abstract
Background FBN1 (15q21.1) encodes fibrillin-1, a large glycoprotein which is a major component of microfibrils that are widely distributed in structural elements of elastic and non-elastic tissues. FBN1 variants are responsible for the related connective tissue disorders, grouped under the generic term of type-1 fibrillinopathies, which include Marfan syndrome (MFS), MASS syndrome (Mitral valve prolapse, Aortic enlargement, Skin and Skeletal findings, Acromicric dysplasia, Familial ectopia lentis, Geleophysic dysplasia 2, Stiff skin syndrome, and dominant Weill-Marchesani syndrome. Case presentation Two siblings presented with isolated skeletal manifestations of MFS, including severe pectus excavatum, elongated face, scoliosis in one case, and absence of other clinical features according to Ghent criteria diagnosis, were screened for detection of variants in whole FBN1 gene (65 exons). Both individuals were heterozygous for the R2726W variant. This variant has been previously reported in association with some skeletal features of Marfan syndrome in the absence of both tall stature and non-skeletal features. These features are consistent with the presentation of the siblings reported here. Conclusion The presented cases confirm that the R2726W FBN1 variant is associated with skeletal features of MFS in the absence of cardiac or ocular findings. These findings confirm that FBN1 variants are associated with a broad phenotypic spectrum and the value of sequencing in atypical cases.
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Affiliation(s)
- Octavio D Reyes-Hernández
- Laboratorio de Genética y Diagnóstico Molecular, Hospital Juárez de México, Instituto Politécnico Nacional 5160, Gustavo A. Madero, Magdalena de Las Salinas, Ciudad de México, DF, 07760, Mexico.
| | - Carmen Palacios-Reyes
- Laboratorio de Genética y Diagnóstico Molecular, Hospital Juárez de México, Instituto Politécnico Nacional 5160, Gustavo A. Madero, Magdalena de Las Salinas, Ciudad de México, DF, 07760, Mexico.
| | - Sonia Chávez-Ocaña
- Laboratorio de Genética y Diagnóstico Molecular, Hospital Juárez de México, Instituto Politécnico Nacional 5160, Gustavo A. Madero, Magdalena de Las Salinas, Ciudad de México, DF, 07760, Mexico.
| | - Enoc M Cortés-Malagón
- Laboratorio de Genética y Diagnóstico Molecular, Hospital Juárez de México, Instituto Politécnico Nacional 5160, Gustavo A. Madero, Magdalena de Las Salinas, Ciudad de México, DF, 07760, Mexico.
| | - Patricia Garcia Alonso-Themann
- Seguimiento Pediátrico, Instituto Nacional de Perinatología, Montes Urales 800 Col. Lomas de Chapultepec, Del. Miguel Hidalgo, 11000, Ciudad de México, Mexico.
| | - Víctor Ramos-Cano
- Servicio de Cirugía Cardio-torácica, Hospital Juárez de México. Av, Instituto Politécnico Nacional 5160, Gustavo A. Madero, Magdalena de Las Salinas, 07760, Ciudad de México, Mexico.
| | - Julián Ramírez-Bello
- Laboratorio de Medicina Genómica, Hospital Juárez de México, Instituto Politécnico Nacional 5160, Gustavo A. Madero, Magdalena de Las Salinas, 07760, Ciudad de México, Mexico.
| | - Mónica Sierra-Martínez
- Laboratorio de Genética y Diagnóstico Molecular, Hospital Juárez de México, Instituto Politécnico Nacional 5160, Gustavo A. Madero, Magdalena de Las Salinas, Ciudad de México, DF, 07760, Mexico.
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10
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Cattalini M, Khubchandani R, Cimaz R. When flexibility is not necessarily a virtue: a review of hypermobility syndromes and chronic or recurrent musculoskeletal pain in children. Pediatr Rheumatol Online J 2015; 13:40. [PMID: 26444669 PMCID: PMC4596461 DOI: 10.1186/s12969-015-0039-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 10/01/2015] [Indexed: 01/09/2023] Open
Abstract
Chronic or recurrent musculoskeletal pain is a common complaint in children. Among the most common causes for this problem are different conditions associated with hypermobility. Pediatricians and allied professionals should be well aware of the characteristics of the different syndromes associated with hypermobility and facilitate early recognition and appropriate management. In this review we provide information on Benign Joint Hypermobility Syndrome, Ehlers-Danlos Syndrome, Marfan Syndrome, Loeys-Dietz syndrome and Stickler syndrome, and discuss their characteristics and clinical management.
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Affiliation(s)
- Marco Cattalini
- Pediatric Clinic, University of Brescia and Spedali Civili di Brescia, Brescia, Italy.
| | - Raju Khubchandani
- Pediatric Rheumatology Clinic, Department of Paediatrics, Jaslok Hospital and Research Centre, Mumbai, India.
| | - Rolando Cimaz
- Anna Meyer Children's Hospital and University of Florence, Florence, Italy.
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Hayashi K, Konno T, Tada H, Tani S, Liu L, Fujino N, Nohara A, Hodatsu A, Tsuda T, Tanaka Y, Kawashiri MA, Ino H, Makita N, Yamagishi M. Functional Characterization of Rare Variants Implicated in Susceptibility to Lone Atrial Fibrillation. Circ Arrhythm Electrophysiol 2015; 8:1095-104. [PMID: 26129877 DOI: 10.1161/circep.114.002519] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 06/19/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Few rare variants in atrial fibrillation (AF)-associated genes have been functionally characterized to identify a causal relationship between these variants and development of AF. We here sought to determine the clinical effect of rare variants in AF-associated genes in patients with lone AF and characterized these variants electrophysiologically and bioinformatically. METHODS AND RESULTS We screened all coding regions in 12 AF-associated genes in 90 patients with lone AF, with an onset of 47±11 years (66 men; mean age, 56±13 years) by high-resolution melting curve analysis and DNA sequencing. The potassium and sodium currents were analyzed using whole-cell patch clamping. In addition to using 4 individual in silico prediction tools, we extended those predictions to an integrated tool (Combined Annotation Dependent Depletion). We identified 7 rare variants in KCNA5, KCNQ1, KCNH2, SCN5A, and SCN1B genes in 8 patients: 2 of 8 probands had a family history of AF. Electrophysiological studies revealed that 2 variants showed a loss-of-function, and 4 variants showed a gain-of-function. Five of 6 variants with electrophysiological abnormalities were predicted as pathogenic by Combined Annotation Dependent Depletion scores. CONCLUSIONS In our cohort of patients with lone AF, 7 rare variants in cardiac ion channels were identified in 8 probands. A combination of electrophysiological studies and in silico predictions showed that these variants could contribute to the development of lone AF, although further in vivo study is necessary to confirm these results. More than half of AF-associated rare variants showed gain-of-function behavior, which may be targeted using genotype-specific pharmacological therapy.
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Affiliation(s)
- Kenshi Hayashi
- From the Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan (K.H., T.K., H.T., S.T., L.L., N.F., A.N., A.H., T.T., Y.T., M.K., M.Y.); Department of Cardiology, Komatsu Municipal Hospital, Komatsu, Japan (H.I.); and Department of Molecular Physiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (N.M.).
| | - Tetsuo Konno
- From the Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan (K.H., T.K., H.T., S.T., L.L., N.F., A.N., A.H., T.T., Y.T., M.K., M.Y.); Department of Cardiology, Komatsu Municipal Hospital, Komatsu, Japan (H.I.); and Department of Molecular Physiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (N.M.)
| | - Hayato Tada
- From the Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan (K.H., T.K., H.T., S.T., L.L., N.F., A.N., A.H., T.T., Y.T., M.K., M.Y.); Department of Cardiology, Komatsu Municipal Hospital, Komatsu, Japan (H.I.); and Department of Molecular Physiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (N.M.)
| | - Satoyuki Tani
- From the Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan (K.H., T.K., H.T., S.T., L.L., N.F., A.N., A.H., T.T., Y.T., M.K., M.Y.); Department of Cardiology, Komatsu Municipal Hospital, Komatsu, Japan (H.I.); and Department of Molecular Physiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (N.M.)
| | - Li Liu
- From the Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan (K.H., T.K., H.T., S.T., L.L., N.F., A.N., A.H., T.T., Y.T., M.K., M.Y.); Department of Cardiology, Komatsu Municipal Hospital, Komatsu, Japan (H.I.); and Department of Molecular Physiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (N.M.)
| | - Noboru Fujino
- From the Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan (K.H., T.K., H.T., S.T., L.L., N.F., A.N., A.H., T.T., Y.T., M.K., M.Y.); Department of Cardiology, Komatsu Municipal Hospital, Komatsu, Japan (H.I.); and Department of Molecular Physiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (N.M.)
| | - Atsushi Nohara
- From the Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan (K.H., T.K., H.T., S.T., L.L., N.F., A.N., A.H., T.T., Y.T., M.K., M.Y.); Department of Cardiology, Komatsu Municipal Hospital, Komatsu, Japan (H.I.); and Department of Molecular Physiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (N.M.)
| | - Akihiko Hodatsu
- From the Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan (K.H., T.K., H.T., S.T., L.L., N.F., A.N., A.H., T.T., Y.T., M.K., M.Y.); Department of Cardiology, Komatsu Municipal Hospital, Komatsu, Japan (H.I.); and Department of Molecular Physiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (N.M.)
| | - Toyonobu Tsuda
- From the Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan (K.H., T.K., H.T., S.T., L.L., N.F., A.N., A.H., T.T., Y.T., M.K., M.Y.); Department of Cardiology, Komatsu Municipal Hospital, Komatsu, Japan (H.I.); and Department of Molecular Physiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (N.M.)
| | - Yoshihiro Tanaka
- From the Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan (K.H., T.K., H.T., S.T., L.L., N.F., A.N., A.H., T.T., Y.T., M.K., M.Y.); Department of Cardiology, Komatsu Municipal Hospital, Komatsu, Japan (H.I.); and Department of Molecular Physiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (N.M.)
| | - Masa-aki Kawashiri
- From the Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan (K.H., T.K., H.T., S.T., L.L., N.F., A.N., A.H., T.T., Y.T., M.K., M.Y.); Department of Cardiology, Komatsu Municipal Hospital, Komatsu, Japan (H.I.); and Department of Molecular Physiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (N.M.)
| | - Hidekazu Ino
- From the Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan (K.H., T.K., H.T., S.T., L.L., N.F., A.N., A.H., T.T., Y.T., M.K., M.Y.); Department of Cardiology, Komatsu Municipal Hospital, Komatsu, Japan (H.I.); and Department of Molecular Physiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (N.M.)
| | - Naomasa Makita
- From the Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan (K.H., T.K., H.T., S.T., L.L., N.F., A.N., A.H., T.T., Y.T., M.K., M.Y.); Department of Cardiology, Komatsu Municipal Hospital, Komatsu, Japan (H.I.); and Department of Molecular Physiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (N.M.)
| | - Masakazu Yamagishi
- From the Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan (K.H., T.K., H.T., S.T., L.L., N.F., A.N., A.H., T.T., Y.T., M.K., M.Y.); Department of Cardiology, Komatsu Municipal Hospital, Komatsu, Japan (H.I.); and Department of Molecular Physiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (N.M.)
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Ramachandra CJA, Mehta A, Guo KWQ, Wong P, Tan JL, Shim W. Molecular pathogenesis of Marfan syndrome. Int J Cardiol 2015; 187:585-91. [PMID: 25863307 DOI: 10.1016/j.ijcard.2015.03.423] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 03/26/2015] [Accepted: 03/30/2015] [Indexed: 01/01/2023]
Abstract
Marfan syndrome (MFS) is a genetic disorder that affects multiple organs. Mortality imposed by aortic aneurysm and dissections represent the most serious clinical manifestation of MFS. Progressive pathological aortic root enlargement as the result of degeneration of microfibril architecture and consequential loss of extracellular matrix integrity due to fibrillin-1 (FBN1) mutations are commonly diagnosed clinical manifestations of MFS. However, overlapping clinical manifestations with other aneurysmal disorders present a significant challenge in early and accurate diagnosis of MFS. While FBN1 mutations, abnormal transforming growth factor-β signaling and dysregulated matrix metalloproteinases have been implicated in MFS, clinically accepted risk-stratifying biomarkers have yet to be reliably identified. In this review, we summarize current consensus and recent insights in the understanding of MFS pathogenesis. Finally, we introduce the application of induced pluripotent stem cells (iPSCs) as cellular models for MFS and its potential as a novel platform into providing better appreciation of mechanisms underlying MFS diverse manifestations in the cardiovascular system.
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Affiliation(s)
| | - Ashish Mehta
- National Heart Research Institute Singapore, Singapore
| | | | - Philip Wong
- National Heart Research Institute Singapore, Singapore; Department of Cardiology, National Heart Centre Singapore, Singapore; Cardiovascular & Metabolic Disorders Program, DUKE-NUS Graduate Medical School, Singapore
| | - Ju Le Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Winston Shim
- National Heart Research Institute Singapore, Singapore; Cardiovascular & Metabolic Disorders Program, DUKE-NUS Graduate Medical School, Singapore.
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Groth KA, Gaustadnes M, Thorsen K, Østergaard JR, Jensen UB, Gravholt CH, Andersen NH. Difficulties in diagnosing Marfan syndrome using current FBN1 databases. Genet Med 2015; 18:98-102. [PMID: 25812041 DOI: 10.1038/gim.2015.32] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 02/09/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The diagnostic criteria of Marfan syndrome (MFS) highlight the importance of a FBN1 mutation test in diagnosing MFS. As genetic sequencing becomes better, cheaper, and more accessible, the expected increase in the number of genetic tests will become evident, resulting in numerous genetic variants that need to be evaluated for disease-causing effects based on database information. The aim of this study was to evaluate genetic variants in four databases and review the relevant literature. METHODS We assessed background data on 23 common variants registered in ESP6500 and classified as causing MFS in the Human Gene Mutation Database (HGMD). We evaluated data in four variant databases (HGMD, UMD-FBN1, ClinVar, and UniProt) according to the diagnostic criteria for MFS and compared the results with the classification of each variant in the four databases. RESULTS None of the 23 variants was clearly associated with MFS, even though all classifications in the databases stated otherwise. CONCLUSION A genetic diagnosis of MFS cannot reliably be based on current variant databases because they contain incorrectly interpreted conclusions on variants. Variants must be evaluated by time-consuming review of the background material in the databases and by combining these data with expert knowledge on MFS. This is a major problem because we expect even more genetic test results in the near future as a result of the reduced cost and process time for next-generation sequencing.Genet Med 18 1, 98-102.
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Affiliation(s)
- Kristian A Groth
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Gaustadnes
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kasper Thorsen
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - John R Østergaard
- Centre for Rare Diseases, Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Uffe Birk Jensen
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - Claus H Gravholt
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Niels H Andersen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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