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Sezer A, Özdemir Z, Özkan E, Çetinkaya S. Atypical presentation of ACCES syndrome resembling dominant Spondyloepiphyseal dysplasia tarda. Am J Med Genet A 2024:e63852. [PMID: 39149811 DOI: 10.1002/ajmg.a.63852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 07/27/2024] [Accepted: 08/05/2024] [Indexed: 08/17/2024]
Abstract
Aplasia Cutis Congenita with Ectrodactyly Skeletal Syndrome (ACCES, OMIM #619959) is an extremely rare multiple congenital anomalies syndrome caused by haploinsufficiency of the UBA2 gene. This syndrome presents with growth retardation, dysmorphic facial features, neurodevelopmental delay, skeletal problems including ectrodactyly, developmental dysplasia of the hip (DDH) and scoliosis, skin findings such as aplasia cutis, and some internal organ abnormalities. Our 13-year-old female patient and her 38-year-old father had a skeletal dysplasia phenotype with disproportionate short stature, bilateral DDH, mild epiphyseal involvement, scoliosis, and increased lumbar lordosis. Both were neurodevelopmentally normal and had mild dysmorphic facial features and mild ectodermal findings. The dominant inheritance pattern in the pedigree suggested a pre-diagnosis of spondyloepiphyseal dysplasia tarda. The exome sequencing analysis of the patient has identified a novel heterozygous variant, NM_005499.2:c.460-2A >G, in the UBA2 gene, and the father was found heterozygous either. The isolated spondyloepiphyseal involvement of our patients was an unusual presentation compared to patients with ACCES syndrome previously reported in the literature. Considering the highly variable expressiveness of ACCES syndrome and the co-occurrence of familial hip dysplasia and vertebral problems, we suggest that this syndrome can also be classified under "Spondyloepi(meta)physial dysplasia (SE(M)D)" in the nosology of genetic skeletal disorders.
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Affiliation(s)
- Abdullah Sezer
- Department of Medical Genetics, Ankara Etlik City Hospital, Ankara, Türkiye
| | - Zeynep Özdemir
- Department of Medical Genetics, Ankara Etlik City Hospital, Ankara, Türkiye
| | - Erdem Özkan
- Department of Radiology, Ankara Etlik City Hospital, Ankara, Türkiye
| | - Semra Çetinkaya
- Department of Pediatric Endocrinology, Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Ankara, Türkiye
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Gombosh M, Proskorovski-Ohayon R, Yogev Y, Eskin-Schwartz M, Hadar N, Aharoni S, Dolgin V, Cohen E, Birk OS. Developmental dysplasia of the hip caused by homozygous TRIM33 pathogenic variant affecting downstream BMP pathway. J Med Genet 2024:jmg-2024-109928. [PMID: 39054052 DOI: 10.1136/jmg-2024-109928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 07/09/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH), formerly termed congenital dislocation of the hip, is the most common congenital disease of the musculoskeletal system in newborns. While familial predilection to DDH has been well documented, the molecular genetics/pathways of this common disorder are poorly understood. METHODS Linkage analysis and whole exome sequencing; real-time PCR studies of skin fibroblasts. RESULTS Consanguineous Bedouin kindred presented with DDH with apparent autosomal recessive heredity. Linkage analysis and whole exome sequencing delineated a single 3.2 Mbp disease-associated chromosome 1 locus (maximal multipoint Logarithm of the Odds score 2.3), containing a single homozygous variant with a relevant expression pattern: addition of threonine in TRIM33 (NM_015906.4); c.1648_1650dup. TRIM33 encodes a protein that acts both in the TGF-β and the BMP pathways; however, it has been mostly studied regarding its function in the TGF-β pathway. Since BMPs are known to act in bone formation, we focused on the BMP pathway, in which TRIM33 functions as a transcription factor, both an activator and repressor. Skin fibroblasts of two affected girls and a heterozygous TRIM33 variant carrier were assayed through reverse-transcription PCR for expression of genes known to be downstream of TRIM33 in the BMP pathway: fibroblasts of affected individuals showed significantly reduced expression of DLX5, significantly increased expression of BGLAP, increased expression of ALPL and no change in expression of RUNX2 or of TRIM33 itself. CONCLUSIONS DDH can be caused by a biallelic variant in TRIM33, affecting the BMP pathway.
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Affiliation(s)
- Maya Gombosh
- Morris Kahn Laboratory of Human Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Regina Proskorovski-Ohayon
- Morris Kahn Laboratory of Human Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yuval Yogev
- Morris Kahn Laboratory of Human Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Marina Eskin-Schwartz
- Morris Kahn Laboratory of Human Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Institute for Human Genetics, Soroka Medical Center, Beer Sheva, Israel
| | - Noam Hadar
- Morris Kahn Laboratory of Human Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sarit Aharoni
- Morris Kahn Laboratory of Human Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Vadim Dolgin
- Morris Kahn Laboratory of Human Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eugen Cohen
- Department of Orthopedics, Soroka Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Ohad S Birk
- Morris Kahn Laboratory of Human Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Institute for Human Genetics, Soroka Medical Center, Beer Sheva, Israel
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Mir B, Gaber K, Ghali D, Merabia BG, Lin C, Kishta W. Developmental Foot Deformities in Patients with Connective Tissue Disorders. JBJS Rev 2023; 11:01874474-202302000-00008. [PMID: 36800486 DOI: 10.2106/jbjs.rvw.22.00219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
» Foot deformities make up a large percentage of all orthopaedic complaints in patients with Down syndrome, Marfan syndrome, Ehlers-Danlos syndrome, Larsen syndrome, and osteogenesis imperfecta. » Some common causes of foot deformities in these conditions include increased ligament laxity, hypotonia, and hypermobility of the joints. » Treatment options for syndromic foot deformities include the use of foot orthoses, physical therapy, bracing, and various surgical procedures. » There is limited evidence supporting the use of surgical intervention to correct foot deformities associated with Down syndrome, Marfan syndrome, Ehlers-Danlos syndrome, Larsen syndrome, and osteogenesis imperfecta. Therefore, further research is needed to determine the short-term and long-term outcomes of these procedures.
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Affiliation(s)
- Basit Mir
- Ashford and St. Peter's Hospitals NHS Foundation Trust, Chertsey, Surrey, United Kingdom
| | - Karim Gaber
- Department of Orthopaedic Surgery, Mansoura International Hospital, Mansoura, Egypt
| | - Daniel Ghali
- Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Celina Lin
- Division of Physical Medicine and Rehabilitation, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Waleed Kishta
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Korshunov A, Vagner V, Konev V, Moskovskiy S, Kuryatnikov K, Skurikhina A, Yakovlev V, Nurakhmetova A. Research of connective tissue dysplasia influence on teething. Saudi Dent J 2022; 34:385-389. [PMID: 35814839 PMCID: PMC9263759 DOI: 10.1016/j.sdentj.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 05/05/2022] [Accepted: 05/08/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose This work aimed to study the rate and quality of maturation of the mineral component of retained teeth 3.8, 4.8 and lower jaw fragment of a human in connective tissue dysplasia in different periods of postpartum ontogenesis. Methods The study involved 102 men (76 with connective tissue dysplasia and 26 without connective tissue dysplasia) divided into groups by age: 31–40, 41–50, 51–60 years. One tooth 3.8, 4.8 and a fragment of the alveolar part of the lower jaw in the projection of teeth 3.8, 4.8 0.5*0.5 cm in size were extracted from each examinee for medical indications. Results Low optical density values are observed at the age of 41–50 years, at the age of 51–60 years, indicating decreased mineral density and the presence of total areas of hypomineralization from the age 31–40 years in connective tissue dysplasia. At the age of 41–50, 51–60 years, at the boundary of connective tissue structures and periosteum, a pronounced sclerosis and deformation of delineation elements were observed; at the age of 31–40 years, the indicated changes were less pronounced. At the age of 31–40 years, the level of bone plate dissection has a local character, after 40 years, it has a generalized character. Conclusion Progressive osteoporosis of the mandible and incomplete amelogenesis are an obstacle to the correct and harmonious teething of the lower wisdom teeth after the age of 30.
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Mandel M, Saloky K, Mirenda W, Seeley A, Seeley M. Hip Dysplasia and Osteogenesis Imperfecta: A Case Report. JBJS Case Connect 2020; 10:e20.00369. [PMID: 33433965 DOI: 10.2106/jbjs.cc.20.00369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
CASE A 1-week-old female patient presented to our clinic with bilateral dislocated hips and was subsequently treated in a Pavlik harness. Harness treatment failed requiring a closed reduction and spica cast application. In the Post-Anesthesia Care Unit (PACU), the patient was found to have a right humerus fracture. Six weeks after cast application, the patient was found to have nondisplaced bilateral femur fractures prompting a genetics evaluation. The patient was subsequently found to have osteogenesis imperfecta type 3. CONCLUSION Perioperative fractures in pediatric patients should raise suspicion for osteogenesis imperfecta. Early diagnosis can improve the management of hip dysplasia and allow for early bisphosphonate therapy.
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Affiliation(s)
- Mark Mandel
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Kaitlin Saloky
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | | | | | - Mark Seeley
- Geisinger Medical Center, Danville, Pennsylvania
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Kraeutler MJ, Safran MR, Scillia AJ, Ayeni OR, Garabekyan T, Mei-Dan O. A Contemporary Look at the Evaluation and Treatment of Adult Borderline and Frank Hip Dysplasia. Am J Sports Med 2020; 48:2314-2323. [PMID: 31725329 DOI: 10.1177/0363546519881411] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Adult hip dysplasia is often diagnosed according to the lateral center-edge angle (LCEA). Patients with frank hip dysplasia (LCEA <20°) traditionally require treatment with bony realignment through a periacetabular osteotomy (PAO) and/or derotational femoral osteotomy, while patients with borderline hip dysplasia (BHD) present a challenging treatment dilemma, as it remains unknown when they should be treated with hip arthroscopy and/or a PAO. PURPOSE To perform a narrative review to report the differences in hip morphology and clinical outcomes between adult patients with frank hip dysplasia and BHD. STUDY DESIGN Narrative review. METHODS A systematic search of the literature was conducted through the Medline, EMBASE, and Cochrane databases with the search phrase borderline hip dysplasia. RESULTS The search identified 305 articles, of which 48 were considered relevant to this study after screening of titles and abstracts. Four articles discussed new radiographic means of evaluating adult hip dysplasia, 16 articles analyzed morphology of dysplastic hips, and 28 articles described the clinical outcomes of patients with frank hip dysplasia or BHD treated with hip arthroscopy and/or PAO. Because the level of evidence obtained from this search was not adequate for systematic review or meta-analysis, a current concepts review on the diagnosis, hip morphology, and clinical outcomes of patients with frank hip dysplasia or BHD is presented. CONCLUSION Adult hip dysplasia is most commonly diagnosed based on the LCEA; however, the LCEA is an unreliable sole marker for dysplasia, and additional radiographic parameters should be utilized. Furthermore, specific pathology identified on imaging and/or during hip arthroscopy can provide clues to a surgeon when the diagnosis is inconclusive according to history and physical examination alone. While the data support that patients with frank dysplasia are best treated with PAO, there is no such preferred treatment for patients with BHD, who have a wide spectrum of instability. Selective use of arthroscopic labral and capsular treatment alone may provide good results in carefully chosen patients with BHD, while some may end up requiring a bony realignment procedure.
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Affiliation(s)
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, California, USA
| | - Anthony J Scillia
- St Joseph's University Medical Center, Paterson, New Jersey, USA.,New Jersey Orthopaedic Institute, Wayne, New Jersey, USA
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | | | - Omer Mei-Dan
- Department of Orthopedics, School of Medicine, University of Colorado, Aurora, Colorado, USA
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