2
|
Radiographic features of the skeleton in disorders of post-squalene cholesterol biosynthesis. Pediatr Radiol 2015; 45:965-76. [PMID: 25646736 DOI: 10.1007/s00247-014-3257-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 11/05/2014] [Accepted: 11/26/2014] [Indexed: 01/26/2023]
Abstract
Disorders of post-squalene cholesterol biosynthesis are inborn errors of metabolism characterised by multiple congenital abnormalities, including significant skeletal involvement. The most frequent and best-characterised example is the Smith-Lemli-Opitz syndrome. Nine other disorders are known, namely autosomal-recessive Antley-Bixler syndrome, Greenberg dysplasia, X-linked dominant chondrodysplasia punctata, X-linked recessive male emopamil-binding protein deficiency, CHILD syndrome, CK syndrome, sterol C4 methyloxidase-like deficiency, desmosterolosis and lathosterolosis. This study provides an overview of the radiologic features observed in these diseases. A common pattern of limb abnormalities is recognisable, including polydactyly, which is typically post-axial and rarely interdigital and can involve all four limbs, and syndactyly of the toes. Chondrodysplasia punctata is specifically associated with a subgroup of disorders of cholesterol biosynthesis (Greenberg dysplasia, CHILD syndrome, X-linked dominant chondrodysplasia punctata, male emopamil-binding protein deficiency). The possible occurrence of epiphyseal stippling in the Smith-Lemli-Opitz syndrome, initially reported, does not appear to be confirmed. Stippling is also associated with other congenital disorders such as chromosomal abnormalities, brachytelephalangic chondrodysplasia punctata (X-linked recessive chondrodysplasia punctata, disruptions of vitamin K metabolism, maternal autoimmune diseases), rhizomelic chondrodysplasia punctata (peroxisomal disorders) and lysosomal storage disorders. In the differential diagnosis of epiphyseal stippling, a moth-eaten appearance of bones, asymmetry, or presence of a common pattern of limb abnormalities indicate inborn errors of cholesterol biosynthesis. We highlight the specific differentiating radiologic features of disorders of post-squalene cholesterol biosynthesis.
Collapse
|
3
|
Lefebvre M, Dufernez F, Bruel AL, Gonzales M, Aral B, Saint-Onge J, Gigot N, Desir J, Daelemans C, Jossic F, Schmitt S, Mangione R, Pelluard F, Vincent-Delorme C, Labaune JM, Bigi N, D'Olne D, Delezoide AL, Toutain A, Blesson S, Cormier-Daire V, Thevenon J, El Chehadeh S, Masurel-Paulet A, Joyé N, Vibert-Guigue C, Rigonnot L, Rousseau T, Vabres P, Hervé P, Lamazière A, Rivière JB, Faivre L, Laurent N, Thauvin-Robinet C. Severe X-linked chondrodysplasia punctata in nine new female fetuses. Prenat Diagn 2015; 35:675-84. [PMID: 25754886 DOI: 10.1002/pd.4591] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 02/09/2015] [Accepted: 02/28/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Conradi-Hünermann-Happle [X-linked dominant chondrodysplasia punctata 2 (CDPX2)] syndrome is a rare X-linked dominant skeletal dysplasia usually lethal in men while affected women show wide clinical heterogeneity. Different EBP mutations have been reported. Severe female cases have rarely been reported, with only six antenatal presentations. METHODS To better characterize the phenotype in female fetuses, we included nine antenatally diagnosed cases of women with EBP mutations. All cases were de novo except for two fetuses with an affected mother and one case of germinal mosaicism. RESULTS The mean age at diagnosis was 22 weeks of gestation. The ultrasound features mainly included bone abnormalities: shortening (8/9 cases) and bowing of the long bones (5/9), punctuate epiphysis (7/9) and an irregular aspect of the spine (5/9). Postnatal X-rays and examination showed ichthyosis (8/9) and epiphyseal stippling (9/9), with frequent asymmetric short and bowed long bones. The X-inactivation pattern of the familial case revealed skewed X-inactivation in the mildly symptomatic mother and random X-inactivation in the severe fetal case. Differently affected skin samples of the same fetus revealed different patterns of X-inactivation. CONCLUSION Prenatal detection of asymmetric shortening and bowing of the long bones and cartilage stippling should raise the possibility of CPDX2 in female fetuses, especially because the majority of such cases involve de novo mutations.
Collapse
Affiliation(s)
- Mathilde Lefebvre
- Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'Est, FHU-TRANSLAD, CHU Dijon, France.,GAD: EA4271 « Génétique des Anomalies du Développement » (GAD), FHU-TRANSLAD, Université de Bourgogne, Dijon, France.,Service d'Anatomo-Pathologie, Faculté de Médecine de Dijon, Dijon, France
| | - Fabienne Dufernez
- APHP, Hôpital Saint-Antoine, Biochimie B, Laboratoire de Référence pour le Diagnostic Génétique des Maladies Rares, Paris, France
| | - Ange-Line Bruel
- GAD: EA4271 « Génétique des Anomalies du Développement » (GAD), FHU-TRANSLAD, Université de Bourgogne, Dijon, France
| | - Marie Gonzales
- Service de Génétique et d'Embryologie Médicales, Université Paris VI, Hôpital Trousseau, Paris, France
| | - Bernard Aral
- Laboratoire de Génétique Moléculaire, CHU Dijon, France
| | | | - Nadège Gigot
- Laboratoire de Génétique Moléculaire, CHU Dijon, France
| | - Julie Desir
- Center for Medical Genetics, Hospital Erasme, ULB, Brussels, Belgium
| | - Caroline Daelemans
- Institut de Recherches Interdisciplinaires en Biologie Humaine et Moléculaire, Hôpital Erasme, Université Libre de Bruxelles, Brussel, Belgium
| | | | | | | | - Fanny Pelluard
- Service de pathologie, CHU de Bordeaux, Bordeaux, France
| | | | | | - Nicole Bigi
- Génétique médicale, CHRU Arnaud de Villeneuve, Montpellier, France
| | | | | | - Annick Toutain
- Service de Génétique, Centre Hospitalo-Universitaire Tours, Tours, France
| | - Sophie Blesson
- Service de Génétique, Centre Hospitalo-Universitaire Tours, Tours, France
| | | | - Julien Thevenon
- GAD: EA4271 « Génétique des Anomalies du Développement » (GAD), FHU-TRANSLAD, Université de Bourgogne, Dijon, France
| | - Salima El Chehadeh
- Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'Est, FHU-TRANSLAD, CHU Dijon, France.,GAD: EA4271 « Génétique des Anomalies du Développement » (GAD), FHU-TRANSLAD, Université de Bourgogne, Dijon, France
| | - Alice Masurel-Paulet
- Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'Est, FHU-TRANSLAD, CHU Dijon, France
| | - Nicole Joyé
- Service de Génétique et d'Embryologie Médicales, Université Paris VI, Hôpital Trousseau, Paris, France
| | - Claude Vibert-Guigue
- Service de Gynécologie-Obstétrique, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Luc Rigonnot
- Service de Gynécologie-Obstétrique, Centre Hospitalier Sud Francilien (CHSF), Corbeil-Essonnes, France
| | | | - Pierre Vabres
- GAD: EA4271 « Génétique des Anomalies du Développement » (GAD), FHU-TRANSLAD, Université de Bourgogne, Dijon, France.,Service de dermatologie, Hôpital Le Bocage, Dijon, France
| | - Philippe Hervé
- Service de Gynécologie, Centre Hospitalo-Universitaire Tours, Tours, France
| | - Antonin Lamazière
- Laboratory of Mass Spectrometry-APLIPID, Faculté de Médecine Pierre et Marie Curie, ER7-UPMC, Paris, France
| | - Jean-Baptiste Rivière
- GAD: EA4271 « Génétique des Anomalies du Développement » (GAD), FHU-TRANSLAD, Université de Bourgogne, Dijon, France.,Laboratoire de Génétique Moléculaire, CHU Dijon, France
| | - Laurence Faivre
- Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'Est, FHU-TRANSLAD, CHU Dijon, France.,GAD: EA4271 « Génétique des Anomalies du Développement » (GAD), FHU-TRANSLAD, Université de Bourgogne, Dijon, France
| | - Nicole Laurent
- Service d'Anatomo-Pathologie, Faculté de Médecine de Dijon, Dijon, France
| | - Christel Thauvin-Robinet
- Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'Est, FHU-TRANSLAD, CHU Dijon, France.,GAD: EA4271 « Génétique des Anomalies du Développement » (GAD), FHU-TRANSLAD, Université de Bourgogne, Dijon, France
| |
Collapse
|
4
|
Cañueto J, Girós M, González-Sarmiento R. The role of the abnormalities in the distal pathway of cholesterol biosynthesis in the Conradi-Hünermann-Happle syndrome. Biochim Biophys Acta Mol Cell Biol Lipids 2013; 1841:336-44. [PMID: 24036494 DOI: 10.1016/j.bbalip.2013.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 09/02/2013] [Accepted: 09/04/2013] [Indexed: 11/28/2022]
Abstract
Conradi-Hünermann-Happle syndrome (CDPX2, OMIM 302960) is an inherited X-linked dominant variant of chondrodysplasia punctata (CP) caused by mutations in one gene of the distal pathway of cholesterol biosynthesis. It exhibits intense phenotypic variation and primarily affects the skin, bones and eyes. The ichthyosis following Blaschko's lines, chondrodysplasia punctata and cataracts are the typical clinical findings. The cardinal biochemical features are an increase in 8(9)-cholestenol and 8-dehydrocholesterol (8DHC), which suggest a deficiency in 3β-hydroxysteroid-Δ8,Δ7-isomerase, also called emopamil binding protein (EBP). The EBP gene is located on the short arm of the X chromosome (Xp11.22-p11.23) and encodes a 230 amino acid protein with dual function. Explaining the clinical phenotype in CDPX2 implies an understanding of both the genetics and biochemical features of this disease. CDPX2 displays an X-linked dominant pattern of inheritance, which is responsible for the distribution of lesions in some tissues. The clinical phenotype in CDPX2 results directly from impairment in cholesterol biosynthesis, and indirectly from abnormalities in the hedgehog signaling protein pathways. This article is part of a Special Issue entitled The Important Role of Lipids in the Epidermis and their Role in the Formation and Maintenance of the Cutaneous Barrier. Guest Editors: Kenneth R. Feingold and Peter Elias.
Collapse
Affiliation(s)
- Javier Cañueto
- Department of Dermatology, University Hospital of Salamanca, Paseo San Vicente 58-182, 37007 Salamanca, Spain; IBSAL (Instituto de Investigación Biosanitaria de Salamanca), Spain.
| | - Marisa Girós
- Seccio Errors Congenits del Metabolisme, Servei de Bioquímica Clínica i Genética Molecular, Hospital Clinic Barcelona, Barcelona, Spain
| | - Rogelio González-Sarmiento
- IBSAL (Instituto de Investigación Biosanitaria de Salamanca), Spain; Molecular Medicine Unit, Faculty of Medicine, University of Salamanca, Campus Miguel de Unamuno S/N, Salamanca 37007, Spain; Laboratory 14, IBMCC-CSIC, University of Salamanca, Campus Miguel de Unamuno S/N, Salamanca 37007, Spain
| |
Collapse
|
6
|
Cañueto J, Girós M, Ciria S, Pi-Castán G, Artigas M, García-Dorado J, García-Patos V, Virós A, Vendrell T, Torrelo A, Hernández-Martín A, Martín-Hernández E, Garcia-Silva MT, Fernández-Burriel M, Rosell J, Tejedor M, Martínez F, Valero J, García JL, Sánchez-Tapia EM, Unamuno P, González-Sarmiento R. Clinical, molecular and biochemical characterization of nine Spanish families with Conradi-Hünermann-Happle syndrome: new insights into X-linked dominant chondrodysplasia punctata with a comprehensive review of the literature. Br J Dermatol 2012; 166:830-8. [PMID: 22121851 DOI: 10.1111/j.1365-2133.2011.10756.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Conradi-Hünermann-Happle syndrome (CDPX2, OMIM 302960) is an inherited X-linked dominant variant of chondrodysplasia punctata which primarily affects the skin, bones and eyes. CDPX2 results from mutations in EBP (emopamil binding protein), and presents with increased levels of sterol precursors 8(9)-cholesterol and 8-dehydrocholesterol. OBJECTIVES To expand the understanding of CDPX2, clinically, biochemically and genetically. METHODS We present one of the largest series reported to date, including 13 female patients belonging to nine Spanish families. Patients were studied biochemically using gas chromatography-mass spectrometry, genetically using polymerase chain reaction and in their methylation status using the HUMARA assay. RESULTS In our cases, there was a clear relationship between abnormal sterol profile and the EBP gene mutation. We describe three novel mutations in the EBP gene. EBP mutations were inherited in three out of nine families and were sporadic in the remaining cases. CONCLUSIONS No clear genotype-phenotype correlation was found. Patients' biochemical profiles did not reveal a relationship between sterol profiles and severity of disease. A skewed X-chromosome inactivation may explain the clinical phenotype in CDPX2 in some familial cases.
Collapse
Affiliation(s)
- J Cañueto
- Department of Dermatology, University Hospital of Salamanca, Salamanca, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Porter FD, Herman GE. Malformation syndromes caused by disorders of cholesterol synthesis. J Lipid Res 2010; 52:6-34. [PMID: 20929975 DOI: 10.1194/jlr.r009548] [Citation(s) in RCA: 311] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Cholesterol homeostasis is critical for normal growth and development. In addition to being a major membrane lipid, cholesterol has multiple biological functions. These roles include being a precursor molecule for the synthesis of steroid hormones, neuroactive steroids, oxysterols, and bile acids. Cholesterol is also essential for the proper maturation and signaling of hedgehog proteins, and thus cholesterol is critical for embryonic development. After birth, most tissues can obtain cholesterol from either endogenous synthesis or exogenous dietary sources, but prior to birth, the human fetal tissues are dependent on endogenous synthesis. Due to the blood-brain barrier, brain tissue cannot utilize dietary or peripherally produced cholesterol. Generally, inborn errors of cholesterol synthesis lead to both a deficiency of cholesterol and increased levels of potentially bioactive or toxic precursor sterols. Over the past couple of decades, a number of human malformation syndromes have been shown to be due to inborn errors of cholesterol synthesis. Herein, we will review clinical and basic science aspects of Smith-Lemli-Opitz syndrome, desmosterolosis, lathosterolosis, HEM dysplasia, X-linked dominant chondrodysplasia punctata, Congenital Hemidysplasia with Ichthyosiform erythroderma and Limb Defects Syndrome, sterol-C-4 methyloxidase-like deficiency, and Antley-Bixler syndrome.
Collapse
Affiliation(s)
- Forbes D Porter
- Program in Developmental Genetics and Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA.
| | | |
Collapse
|
8
|
Hello M, David A, Barbarot S. [Conradi-Hünermann-Happle syndrome with unilateral distribution]. Ann Dermatol Venereol 2009; 137:44-7. [PMID: 20110068 DOI: 10.1016/j.annder.2009.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Accepted: 05/29/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND X-linked dominant chondrodysplasia punctata, also known as Conradi-Hünermann-Happle syndrome or CDPX2, is a rare type of genodermatosis with heterogeneous clinical phenotypes. It is characterized by the association of usually bilateral and symmetrical Blaschko-linear cutaneous lesions, ocular involvement, morphological, and skeletal abnormalities (characteristic punctuate epiphyseal calcifications). CASE REPORT A female newborn was examined for a squamous glazed erythema mainly located on the left half of the body. Standard X-rays of the left wrist showed punctuate epiphyseal calcifications. The diagnosis was confirmed by molecular studies, which revealed a mutation on the gene encoding the 3beta-hydroxy-steroid-Delta(8), Delta(7)-isomerase. DISCUSSION We report the case of a baby girl with mainly unilateral skin lesions of CDPX2, possibly due to mosaicism associated with X-inactivation. A diagnosis of CDPX2 must be considered in the event of a female newborn with ichthyosiform Blaschko-linear cutaneous lesions of atypical topography.
Collapse
Affiliation(s)
- M Hello
- Clinique dermatologique, Hôtel-Dieu, CHU de Nantes, place Alexis-Ricordeau, 44035 Nantes cedex 1, France
| | | | | |
Collapse
|