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Fetta A, Toni F, Pettenuzzo I, Ricci E, Rocca A, Gambi C, Soliani L, Di Pisa V, Martini S, Sperti G, Cagnazzo V, Accorsi P, Bartolini E, Battaglia D, Bernardo P, Canevini MP, Ferrari AR, Giordano L, Locatelli C, Mancardi M, Orsini A, Pippucci T, Pruna D, Rosati A, Suppiej A, Tagliani S, Vaisfeld A, Vignoli A, Izumi K, Krantz I, Cordelli DM. Structural brain abnormalities in Pallister-Killian syndrome: a neuroimaging study of 31 children. Orphanet J Rare Dis 2024; 19:107. [PMID: 38459574 PMCID: PMC10921669 DOI: 10.1186/s13023-024-03065-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/03/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Pallister-Killian syndrome (PKS) is a rare genetic disorder caused by mosaic tetrasomy of 12p with wide neurological involvement. Intellectual disability, developmental delay, behavioral problems, epilepsy, sleep disturbances, and brain malformations have been described in most individuals, with a broad phenotypic spectrum. This observational study, conducted through brain MRI scan analysis on a cohort of patients with genetically confirmed PKS, aims to systematically investigate the neuroradiological features of this syndrome and identify the possible existence of a typical pattern. Moreover, a literature review differentiating the different types of neuroimaging data was conducted for comparison with our population. RESULTS Thirty-one individuals were enrolled (17 females/14 males; age range 0.1-17.5 years old at first MRI). An experienced pediatric neuroradiologist reviewed brain MRIs, blindly to clinical data. Brain abnormalities were observed in all but one individual (compared to the 34% frequency found in the literature review). Corpus callosum abnormalities were found in 20/30 (67%) patients: 6 had callosal hypoplasia; 8 had global hypoplasia with hypoplastic splenium; 4 had only hypoplastic splenium; and 2 had a thin corpus callosum. Cerebral hypoplasia/atrophy was found in 23/31 (74%) and ventriculomegaly in 20/31 (65%). Other frequent features were the enlargement of the cisterna magna in 15/30 (50%) and polymicrogyria in 14/29 (48%). Conversely, the frequency of the latter was found to be 4% from the literature review. Notably, in our population, polymicrogyria was in the perisylvian area in all 14 cases, and it was bilateral in 10/14. CONCLUSIONS Brain abnormalities are very common in PKS and occur much more frequently than previously reported. Bilateral perisylvian polymicrogyria was a main aspect of our population. Our findings provide an additional tool for early diagnosis.Further studies to investigate the possible correlations with both genotype and phenotype may help to define the etiopathogenesis of the neurologic phenotype of this syndrome.
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Affiliation(s)
- Anna Fetta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC di Neuropsichiatria dell'Età Pediatrica, Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, Bologna, Italy
| | - Francesco Toni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma di Neuroradiologia con Tecniche ad elevata complessità- PNTEC, Bologna, Italy
| | - Ilaria Pettenuzzo
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC di Neuropsichiatria dell'Età Pediatrica, Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, Bologna, Italy
| | - Emilia Ricci
- Epilepsy Center, Childhood and Adolescence Neuropsychiatry Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142, Milan, Italy.
| | - Alessandro Rocca
- UO di Pediatria d'Urgenza, IRCCS Policlinico Sant'Orsola, Bologna, Italy
| | - Caterina Gambi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC di Neuropsichiatria dell'Età Pediatrica, Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, Bologna, Italy
| | - Luca Soliani
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC di Neuropsichiatria dell'Età Pediatrica, Bologna, Italy
| | - Veronica Di Pisa
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC di Neuropsichiatria dell'Età Pediatrica, Bologna, Italy
| | - Silvia Martini
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, Bologna, Italy
- Neonatal Intensive Care Unit, IRCCS AOUBO, Bologna, Italy
| | - Giacomo Sperti
- Scuola di Specializzazione in Pediatria - Alma Mater Studiorum, Università di Bologna, Bologna, Italy
| | - Valeria Cagnazzo
- Scuola di Specializzazione in Pediatria - Alma Mater Studiorum, Università di Bologna, Bologna, Italy
| | | | - Emanuele Bartolini
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, 56128, Pisa, Italy
| | - Domenica Battaglia
- Pediatric Neurology, Department of Woman and Child Health and Public Health, Child Health Area, Catholic University UCSC, Rome, Italy
| | - Pia Bernardo
- Department of Neurosciences, Pediatric Psychiatry and Neurology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Maria Paola Canevini
- Epilepsy Center, Childhood and Adolescence Neuropsychiatry Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142, Milan, Italy
| | - Anna Rita Ferrari
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, 56128, Pisa, Italy
| | - Lucio Giordano
- Child Neuropsychiatric Division, Spedali Civili, Brescia, Italy
| | | | - Margherita Mancardi
- Unit of Child Neuropsychiatry, IRCCS Istituto Giannina Gaslini, Epicare Network for Rare Disease, Genoa, Italy
| | - Alessandro Orsini
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Tommaso Pippucci
- U.O. Genetica Medica, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola, Bologna, Emilia- Romagna, Italy
| | - Dario Pruna
- Department of Pediatric Neurology and Epileptology, Pediatric Depatment, ARNAS Brotzu, Cagliari, Italy
| | - Anna Rosati
- Neuroscience Department, Children's Hospital Anna Meyer, University of Florence, Viale Gaetano Pieraccini, 24, 50139, Firenze, Italy
| | - Agnese Suppiej
- Department of Medical Sciences, Pediatric Section, University Hospital of Ferrara, Ferrara, Italy
| | - Sara Tagliani
- Department of Medical Sciences, Pediatric Section, University Hospital of Ferrara, Ferrara, Italy
| | - Alessandro Vaisfeld
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, Bologna, Italy
- U.O. Genetica Medica, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola, Bologna, Emilia- Romagna, Italy
| | - Aglaia Vignoli
- Child Neuropsychiatry Unit, Department of Health Sciences, ASSTGrande Ospedale Metropolitano, Niguarda, Milano, Italy
| | - Kosuke Izumi
- Division of Genetics and Metabolism, Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., 75390, Dallas, TX, USA
| | - Ian Krantz
- Divisions of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Duccio Maria Cordelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC di Neuropsichiatria dell'Età Pediatrica, Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, Bologna, Italy
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2
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Wu X, Xie X, Su L, Lin N, Liang B, Guo N, Chen Q, Xu L, Huang H. Prenatal diagnosis of Pallister-Killian syndrome and literature review. J Cell Mol Med 2021; 25:8929-8935. [PMID: 34405543 PMCID: PMC8435413 DOI: 10.1111/jcmm.16853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 07/31/2021] [Indexed: 01/12/2023] Open
Abstract
Pallister‐Killian syndrome (PKS) is a rare sporadic genetic disorder usually caused by mosaicism of an extra isochromosome of 12p (i(12p)). This retrospective study analysed the prenatal ultrasound manifestations and molecular and cytogenetic results of five PKS foetuses. Samples of amniotic fluid and/or cord blood, skin biopsy and placenta were collected. Conventional karyotyping and single nucleotide polymorphism array (SNP array) were performed on all the amniotic fluid or cord blood samples. Copy number variants sequencing (CNV‐seq) and fluorescence in situ hybridization (FISH) were also used for the validation for one foetus. All the five foetuses were from pregnancies with advanced parental age. Two foetuses involved structural abnormalities and one foetus had only soft markers, all of which included increased nuchal translucency. The rest two foetuses had normal ultrasounds in the second trimester, which has rarely been reported before. The karyotype revealed typical i(12p) in four cases and a small supernumerary marker chromosome consisting of 12p and 20p in the remaining one case. The proportion of cells with i(12p) ranged from 0 to 100% in cultural cells, while SNP array results suggested 2−4 copies of 12p. For one foetus, metaphase FISH showed normal results, but the interphase FISH suggested cell lines with two, three and four copies of 12p in the amniotic fluid. Advanced parental age may be an important risk factor for PKS, and there were no typical ultrasound manifestations related to PKS. A combination of karyotype analysis and molecular diagnosis is an effective method for the diagnosis of PKS.
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Affiliation(s)
- Xiaoqing Wu
- Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Department of Laboratory Medicine, Fujian Medical University, Fuzhou, China
| | - Xiaorui Xie
- Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Linjuan Su
- Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Na Lin
- Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Bin Liang
- Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Nan Guo
- Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qingquan Chen
- Department of Laboratory Medicine, Fujian Medical University, Fuzhou, China
| | - Liangpu Xu
- Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Hailong Huang
- Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
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3
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Pallister-Killian Syndrome versus Trisomy 12p-A Clinical Study of 5 New Cases and a Literature Review. Genes (Basel) 2021; 12:genes12060811. [PMID: 34073526 PMCID: PMC8226674 DOI: 10.3390/genes12060811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/17/2021] [Accepted: 05/24/2021] [Indexed: 11/23/2022] Open
Abstract
Pallister–Killian syndrome (PKS) is a rare, sporadic disorder defined by a characteristic dysmorphic face, pigmentary skin anomalies, intellectual disability, hypotonia, and seizures caused by 12p tetrasomy due to an extra isochromosome 12p. We present three cases of PKS and two cases of trisomy 12p to illustrate and discuss features rarely cited in the literature, present certain particularities that not yet been cited, and analyze the differences between entities. Moreover, we present alternative methods of diagnosis that could be easily used in daily practice. Features not yet or rarely reported in PKS literature include marked excess of hair on the forehead and ears in the first months of life, a particular eye disorder (abnormal iris color with pointed pupil), connective tissue defects, repeated episodes of infection and autonomic dysfunction, endocrine malfunction as a possible cause of postnatal growth deficit, more complex sensory impairments, and mild early myoclonic jerks. After performing different combinations of tests, we conclude that MLPA (follow-up kit P230-B1) or array CGH using DNA extracted from a buccal swab is a reliable method of diagnosis in PKS and we recommend either one as a first intention diagnostic test. In cases without major defects associated (suspicion trisomy 12p), subtelomeric MLPA should be performed first.
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Wang T, Ren C, Chen D, Lu J, Guo L, Zheng L, Liu Y, Chen H. Prenatal diagnosis of Pallister-Killian syndrome using cord blood samples. Mol Cytogenet 2019; 12:39. [PMID: 31497069 PMCID: PMC6717365 DOI: 10.1186/s13039-019-0449-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 07/30/2019] [Indexed: 01/10/2023] Open
Abstract
Background Pallister-Killian syndrome (PKS) (OMIM:#601803) is a rare sporadic genetic disorder characterized by multi-malformations which is caused by the presence of the extra isochromosome 12p. PKS is featured by the tissue-limited mosaicism of the isochromosome 12p [i(12p)]. There were a wide spectrum of prenatal ultrasound findings of PKS, which made it difficult to be found in first or second trimester. Polyhydramnios, diaphragmatic hernia, and rhizomelic limb shortening were the most common prenatal ultrasound abnormalities in PKS. This study retrospectively analyzed the ultrasound findings and molecular cytogenetic results of four PKS fetuses diagnosed by using cord blood samples. Results The ultrasound anomalies of four PKS fetuses are described as follows: fetal macrosomia, cerebral ventriculomegaly, increased NT thickness, rhizomelic limbs shortening, polyhydramnios. Biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL) measurements were above the mean in three fetuses,while one fetus showed rhizomelic limbs shortening. Combined with this study and previous literature, polyhydramnios was the most frequent anomaly observed in prenatal ultrasound examination of PKS, which accounted for 48% (94/194). Fetal macrosomia was present in 15% (29/194), cerebral ventriculomegaly in 13% (25/194), thickened nuchal fold in 9% (18/194), rhizomelic limbs shortening in 26% (51/194). I(12p) was found in the karyotype analysis of cultured cord blood lymphocytes and the mosaic ratios ranged from 2 to 5%. Single nucleotide polymorphisms array (SNP-array) results suggested that the whole short arm of chromosome 12 was duplicated with 2~3 copies. Fluorescence in situ hybridization (FISH) was performed to confirm the results of karyotype and SNP-array. Conclusions In case non-specific indicators such as fetal macrosomia, polyhydramnios and rhizomelic limbs shortening are observed meanwhile in prenatal ultrasound, targeted detection of PKS should be considered. In the prenatal diagnosis of PKS, the combination of SNP-array and FISH with conventional karyotype are the key to seek i(12p) and for precise diagnosis.
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Affiliation(s)
- Ting Wang
- 1Medical Genetic Center, Guangdong Women and Children Hospital, 521 Xingnan Avenue, Panyu, Guangzhou, China
| | - Congmian Ren
- 1Medical Genetic Center, Guangdong Women and Children Hospital, 521 Xingnan Avenue, Panyu, Guangzhou, China
| | - Dan Chen
- 2Ultrasound Diagnosis Department, Guangdong Women and Children Hospital, 521 Xingnan Avenue, Panyu, Guangzhou, China
| | - Jian Lu
- 1Medical Genetic Center, Guangdong Women and Children Hospital, 521 Xingnan Avenue, Panyu, Guangzhou, China
| | - Li Guo
- 1Medical Genetic Center, Guangdong Women and Children Hospital, 521 Xingnan Avenue, Panyu, Guangzhou, China
| | - Laiping Zheng
- 1Medical Genetic Center, Guangdong Women and Children Hospital, 521 Xingnan Avenue, Panyu, Guangzhou, China
| | - Yuan Liu
- 1Medical Genetic Center, Guangdong Women and Children Hospital, 521 Xingnan Avenue, Panyu, Guangzhou, China
| | - Hanbiao Chen
- 1Medical Genetic Center, Guangdong Women and Children Hospital, 521 Xingnan Avenue, Panyu, Guangzhou, China
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5
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Salzano E, Raible SE, Kaur M, Wilkens A, Sperti G, Tilton RK, Bettini LR, Rocca A, Cocchi G, Selicorni A, Conlin LK, McEldrew D, Gupta R, Thakur S, Izumi K, Krantz ID. Prenatal profile of Pallister-Killian syndrome: Retrospective analysis of 114 pregnancies, literature review and approach to prenatal diagnosis. Am J Med Genet A 2018; 176:2575-2586. [PMID: 30289601 DOI: 10.1002/ajmg.a.40499] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/23/2018] [Accepted: 07/14/2018] [Indexed: 01/10/2023]
Abstract
Pallister-Killian syndrome (PKS) is a tissue limited mosaic disorder, characterized by variable degrees of neurodevelopmental delay and intellectual disability, typical craniofacial findings, skin pigmentation anomalies and multiple congenital malformations. The wide phenotypic spectrum of PKS in conjunction with the mosaic distribution of the i(12p) makes PKS an underdiagnosed disorder. Recognition of prenatal findings that should raise a suspicion of PKS is complicated by the fragmentation of data currently available in the literature and challenges in diagnosing a mosaic diagnosis on prenatal testing. Ultrasound anomalies, especially congenital diaphragmatic hernia, congenital heart defects, and rhizomelic limb shortening, have been related to PKS, but they are singularly not specific and are not present in all affected fetuses. We have combined prenatal data from 86 previously published reports and from our cohort of 114 PKS probands (retrospectively reviewed). Summarizing this data we have defined a prenatal growth profile and identified markers of perinatal outcome which collectively provide guidelines for early recognition of the distinctive prenatal profile and consideration of a diagnosis of PKS as well as for management and genetic counseling.
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Affiliation(s)
- E Salzano
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - S E Raible
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - M Kaur
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - A Wilkens
- Division of Genomic Diagnostics, Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - G Sperti
- Neonatology Unit, St. Orsola-Malpighi Polyclinic, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - R K Tilton
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - L R Bettini
- Dipartimento di Scienze Della Salute, San Paolo Hospital Medical School, Università degli Studi di Milano, Milan, Italy
| | - A Rocca
- Neonatology Unit, St. Orsola-Malpighi Polyclinic, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - G Cocchi
- Neonatology Unit, St. Orsola-Malpighi Polyclinic, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | | | - L K Conlin
- Division of Genomic Diagnostics, Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pathology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - D McEldrew
- Division of Genomic Diagnostics, Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - R Gupta
- Department of Fetal Medicine, Maharaja Agrasen Hospital, Delhi & Sonepat Genetic and Fetal Medicine Centre, Sonepat, Haryana
| | - S Thakur
- Department of Genetic & Fetal Medicine, Fortis Hospital, Delhi-NCR & Apollo Hospital, Delhi, India
| | - K Izumi
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Division of Genomic Diagnostics, Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - I D Krantz
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Li L, Huang L, Huang X, Lin S, He Z, Fang Q. Prenatal diagnosis of Pallister-Killian syndrome in one twin. Clin Case Rep 2018; 6:1470-1473. [PMID: 30147884 PMCID: PMC6099054 DOI: 10.1002/ccr3.1624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 04/29/2018] [Accepted: 05/08/2018] [Indexed: 11/11/2022] Open
Abstract
Pallister-Killian syndrome (PKS) is often incidentally diagnosed prenatally due to ultrasound abnormalities or advanced maternal age. Severely shortened limbs could be the most outstanding abnormal observation in a fetus with PKS. PKS can be detected with the highest mosaic ratio by chromosomal microarray analysis (CMA) on uncultured amniocytes prenatally.
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Affiliation(s)
- Lin Li
- Fetal Medicine CenterDepartment of Obstetrics and GynecologyThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Linhuan Huang
- Fetal Medicine CenterDepartment of Obstetrics and GynecologyThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Xuan Huang
- Fetal Medicine CenterDepartment of Obstetrics and GynecologyThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Shaobin Lin
- Fetal Medicine CenterDepartment of Obstetrics and GynecologyThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Zhiming He
- Fetal Medicine CenterDepartment of Obstetrics and GynecologyThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Qun Fang
- Fetal Medicine CenterDepartment of Obstetrics and GynecologyThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
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An inactivating mutation in the histone deacetylase SIRT6 causes human perinatal lethality. Genes Dev 2018; 32:373-388. [PMID: 29555651 PMCID: PMC5900711 DOI: 10.1101/gad.307330.117] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 02/26/2018] [Indexed: 12/27/2022]
Abstract
Ferrer et al. demonstrate that a homozygous inactivating mutation in the histone deacetylase SIRT6 results in severe congenital anomalies and perinatal lethality in four affected fetuses. Human induced pluripotent stem cells derived from D63H homozygous fetuses fail to differentiate into embryoid bodies, functional cardiomyocytes, and neural progenitor cells due to a failure to repress pluripotent genes. It has been well established that histone and DNA modifications are critical to maintaining the equilibrium between pluripotency and differentiation during early embryogenesis. Mutations in key regulators of DNA methylation have shown that the balance between gene regulation and function is critical during neural development in early years of life. However, there have been no identified cases linking epigenetic regulators to aberrant human development and fetal demise. Here, we demonstrate that a homozygous inactivating mutation in the histone deacetylase SIRT6 results in severe congenital anomalies and perinatal lethality in four affected fetuses. In vitro, the amino acid change at Asp63 to a histidine results in virtually complete loss of H3K9 deacetylase and demyristoylase functions. Functionally, SIRT6 D63H mouse embryonic stem cells (mESCs) fail to repress pluripotent gene expression, direct targets of SIRT6, and exhibit an even more severe phenotype than Sirt6-deficient ESCs when differentiated into embryoid bodies (EBs). When terminally differentiated toward cardiomyocyte lineage, D63H mutant mESCs maintain expression of pluripotent genes and fail to form functional cardiomyocyte foci. Last, human induced pluripotent stem cells (iPSCs) derived from D63H homozygous fetuses fail to differentiate into EBs, functional cardiomyocytes, and neural progenitor cells due to a failure to repress pluripotent genes. Altogether, our study described a germline mutation in SIRT6 as a cause for fetal demise, defining SIRT6 as a key factor in human development and identifying the first mutation in a chromatin factor behind a human syndrome of perinatal lethality.
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Poulton C, Baynam G, Yates C, Alinejad-Rokny H, Williams S, Wright H, Woodward KJ, Sivamoorthy S, Peverall J, Shipman P, Ravine D, Beilby J, Heng JIT. A review of structural brain abnormalities in Pallister-Killian syndrome. Mol Genet Genomic Med 2017; 6:92-98. [PMID: 29222831 PMCID: PMC5823685 DOI: 10.1002/mgg3.351] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 10/27/2017] [Accepted: 10/30/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pallister-Killian syndrome (PKS) is a rare multisystem developmental syndrome usually caused by mosaic tetrasomy of chromosome 12p that is known to be associated with neurological defects. METHODS We describe two patients with PKS, one of whom has bilateral perisylvian polymicrogyria (PMG), the other with macrocephaly, enlarged lateral ventricles and hypogenesis of the corpus callosum. We have also summarized the current literature describing brain abnormalities in PKS. RESULTS We reviewed available cases with intracranial scans (n = 93) and found a strong association between PKS and structural brain abnormalities (77.41%; 72/93). Notably, ventricular abnormalities (45.83%; 33/72), abnormalities of the corpus callosum (25.00%; 18/72) and cerebral atrophy (29.17%; 21/72) were the most frequently reported, while macrocephaly (12.5%; 9/72) and PMG (4.17%; 3/72) were less frequent. To further understand how 12p genes might be relevant to brain development, we identified 63 genes which are enriched in the nervous system. These genes display distinct temporal as well as region-specific expression in the brain, suggesting specific roles in neurodevelopment and disease. Finally, we utilized these data to define minimal critical regions on 12p and their constituent genes associated with atrophy, abnormalities of the corpus callosum, and macrocephaly in PKS. CONCLUSION Our study reinforces the association between brain abnormalities and PKS, and documents a diverse neurogenetic basis for structural brain abnormalities and impaired function in children diagnosed with this rare disorder.
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Affiliation(s)
- Cathryn Poulton
- Department of Neurology, Princess Margaret Hospital, Subiaco, WA, Australia
| | - Gareth Baynam
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.,Genetic Services of Western Australia, Perth, WA, Australia.,Office of Population Health Genomics, Public Health and Clinical Services Division, Department of Health, Government of Western Australia, Perth, WA, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia.,Institute for Immunology and Infectious Diseases, Murdoch University, Perth, WA, Australia.,Western Australian Register of Developmental Anomalies, Perth, WA, Australia.,Spatial Sciences, Science and Engineering, Curtin University, Crawley, WA, Australia
| | - Clarissa Yates
- Centre for Medical Research, the University of Western Australia, Nedlands, WA, Australia
| | - Hamid Alinejad-Rokny
- Centre for Medical Research, the University of Western Australia, Nedlands, WA, Australia.,The Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, WA, Australia
| | - Simon Williams
- Department of Neurology, Princess Margaret Hospital, Subiaco, WA, Australia
| | - Helen Wright
- Department of Paediatrics, Princess Margaret Hospital, Subiaco, WA, Australia
| | - Karen J Woodward
- PathWest, Laboratory Medicine WA, Nedlands, WA, Australia.,School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | | | | | - Peter Shipman
- Department of Radiology, Princess Margaret Hospital, Subiaco, WA, Australia
| | - David Ravine
- PathWest, Laboratory Medicine WA, Nedlands, WA, Australia
| | - John Beilby
- PathWest, Laboratory Medicine WA, Nedlands, WA, Australia.,School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - Julian Ik-Tsen Heng
- Centre for Medical Research, the University of Western Australia, Nedlands, WA, Australia.,The Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, WA, Australia.,Curtin Health Innovation Research Institute and Sarich Neuroscience Institute, Curtin University, Crawley, WA, Australia
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9
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Stone L, Tripuraneni R, Bain M, Hernandez C. Pallister-Killian syndrome in a two-year-old boy. Clin Case Rep 2017; 5:774-777. [PMID: 28588808 PMCID: PMC5457980 DOI: 10.1002/ccr3.892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 12/26/2016] [Accepted: 02/10/2017] [Indexed: 11/08/2022] Open
Abstract
Pallister-Killian syndrome (PKS) is a rare, sporadic, multisystem developmental disorder characterized by craniofacial dysmorphic features. We report a case of a two-year-old boy with PKS to highlight the cutaneous findings and emphasize the importance of diagnostic skin biopsies in patients with cutaneous pigmentation changes and distinctive facial features.
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Affiliation(s)
- Leigh Stone
- Department of Dermatology University of Illinois at Chicago 808 South Wood Street Room 376 CME Chicago 60612 Illinois USA
| | - Ramya Tripuraneni
- Department of Dermatology Northwestern University 676 North St. Clair Street Suite 1600 Chicago 60611 Illinois USA
| | - Michelle Bain
- Department of Dermatology University of Illinois at Chicago 808 South Wood Street Room 376 CME Chicago 60612 Illinois USA
| | - Claudia Hernandez
- Department of Dermatology University of Illinois at Chicago 808 South Wood Street Room 376 CME Chicago 60612 Illinois USA
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10
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Kucińska-Chahwan A, Bijok J, Dąbkowska S, Jóźwiak A, Ilnicka A, Nowakowska B, Jakiel G, Roszkowski T. Targeted prenatal diagnosis of Pallister-Killian syndrome. Prenat Diagn 2017; 37:446-452. [PMID: 28233318 DOI: 10.1002/pd.5030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/25/2017] [Accepted: 02/19/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To present five new cases of prenatally diagnosed Pallister-Killian syndrome (PKS) and to propose an approach for a targeted diagnosis. METHOD We retrospectively analyzed ultrasound findings and cytogenetic results in PKS. We also searched through dysmorphology databases for features occurring in PKS that could potentially be seen in prenatal ultrasound examination. RESULTS On the basis of collected data, frequent and distinctive features in fetuses with PKS were established. The most appropriate material and method of testing were proposed. Rhizomelic limb shortening, diaphragmatic hernia, thickened nuchal fold, increased prenasal thickness, polydactyly and polyhydramnios were frequent and distinctive findings in fetuses with PKS. Amniocentesis was the most frequent prenatal procedure for material collection. Percentage of aneuploid cells was higher in amniotic fluid than in cord blood. Cytomolecular tests were useful as confirmation as well as preliminary tests. Cytogenetic identification of the isochromosome was done in all cases except one. CONCLUSIONS In case of ultrasound evaluation of features frequent and distinctive for PKS in second and third trimesters of pregnancy, targeted diagnosis should be considered. Amniotic fluid instead of cord blood collection is preferable. Communication with the laboratory is important because modification of routine procedures enhances a chance for correct diagnosis. © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Anna Kucińska-Chahwan
- I Clinic of Obstetrics and Gynecology, Professor Witold Orłowski Independent Public Clinical Hospital - Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Julia Bijok
- I Clinic of Obstetrics and Gynecology, Professor Witold Orłowski Independent Public Clinical Hospital - Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Sylwia Dąbkowska
- I Clinic of Obstetrics and Gynecology, Professor Witold Orłowski Independent Public Clinical Hospital - Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Anna Jóźwiak
- Department of Genetics, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Alicja Ilnicka
- Department of Genetics, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Beata Nowakowska
- Department of Medical Genetics, Institute of Mother and Child, Warsaw, Poland
| | - Grzegorz Jakiel
- I Clinic of Obstetrics and Gynecology, Professor Witold Orłowski Independent Public Clinical Hospital - Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Tomasz Roszkowski
- I Clinic of Obstetrics and Gynecology, Professor Witold Orłowski Independent Public Clinical Hospital - Centre of Postgraduate Medical Education, Warsaw, Poland
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11
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Desseauve D, Legendre M, Dugué-Maréchaud M, Vequeau-Goua V, Pierre F. [Prenatal and clinicopathological study of 6 cases of Pallister-Killian syndrome and review]. ACTA ACUST UNITED AC 2016; 44:200-6. [PMID: 27032761 DOI: 10.1016/j.gyobfe.2016.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 03/01/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE In multidisciplinary prenatal diagnosis centers, the search for a tetrasomy 12p mosaic is requested following the discovery of a diaphragmatic hernia in the antenatal period. Thus, the series of Pallister Killian syndromes (PKS: OMIM 601803) probably overestimate the prevalence of diaphragmatic hernia in this syndrome to the detriment of other morphological abnormalities. METHODS A multicenter retrospective study was conducted with search for assistance from members of the French society for Fetal Pathology. For each identified case, we collected all antenatal and postnatal data. Antenatal data were compared with data from the clinicopathological examination to assess the adequacy of sonographic signs of PKS. A review of the literature on antenatal morphological anomalies in case of PKS completed the study. RESULTS Ten cases were referred to us: 7 had cytogenetic confirmation and 6 had ultrasound screening. In the prenatal as well as post mortem period, the most common sign is facial dysmorphism (5 cases/6). A malformation of limbs is reported in half of the cases (3 out of 6). Ultrasound examination detected craniofacial dysmorphism in 5 cases out of 6. We found 1 case of left diaphragmatic hernia. Our results are in agreement with the malformation spectrum described in the literature. CONCLUSION Some malformation associations could evoke a SPK without classical diaphragmatic hernia.
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Affiliation(s)
- D Desseauve
- Service de gynécologie-obstétrique et médecine de la reproduction, centre hospitalier universitaire de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers, France.
| | - M Legendre
- Service de génétique clinique, centre hospitalier universitaire de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers, France
| | - M Dugué-Maréchaud
- Service de gynécologie-obstétrique et médecine de la reproduction, centre hospitalier universitaire de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers, France
| | - V Vequeau-Goua
- Service de gynécologie-obstétrique et médecine de la reproduction, centre hospitalier universitaire de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers, France
| | - F Pierre
- Service de gynécologie-obstétrique et médecine de la reproduction, centre hospitalier universitaire de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers, France
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12
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Santamaria A, Laganà AS, Barresi V, Triolo O, Fondacaro NS, Corrado F. Prenatally identified Pallister-Killian syndrome: Ultrasound pattern and diagnostic considerations. J OBSTET GYNAECOL 2015; 36:406-7. [PMID: 26471928 DOI: 10.3109/01443615.2015.1086984] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- A Santamaria
- a Department of Pediatric , Gynecological, Microbiological and Biomedical Sciences, University of Messina , Messina , Italy
| | - A S Laganà
- a Department of Pediatric , Gynecological, Microbiological and Biomedical Sciences, University of Messina , Messina , Italy
| | - V Barresi
- b Department of Human Pathology , University of Messina , Messina , Italy
| | - O Triolo
- a Department of Pediatric , Gynecological, Microbiological and Biomedical Sciences, University of Messina , Messina , Italy
| | - N S Fondacaro
- a Department of Pediatric , Gynecological, Microbiological and Biomedical Sciences, University of Messina , Messina , Italy
| | - F Corrado
- a Department of Pediatric , Gynecological, Microbiological and Biomedical Sciences, University of Messina , Messina , Italy
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