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Alessandri JL, Celse T, Spodenkiewicz M, Calaya A, Dumont C, Jacquemont ML, Bertaut-Nativel B, Boumahni B, Rémy M, Ferroul F, Guilly S, Huby T, Irabé M, Laurens T, Munier P, Morel G, Payet F, Randrianaivo H, Doray B, Dospeux J. Prenatal and neonatal phenotype of Larsen of La Réunion Island syndrome (B4GALT7-linkeropathy). Eur J Med Genet 2024; 69:104940. [PMID: 38705458 DOI: 10.1016/j.ejmg.2024.104940] [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: 11/20/2023] [Revised: 03/14/2024] [Accepted: 04/22/2024] [Indexed: 05/07/2024]
Abstract
Larsen of La Réunion Island syndrome (LRS) is an autosomal recessive condition associated with multiple large joint dislocations, clubfeet, severe dwarfism, and distinctive facial features. LRS is caused by a recurrent homozygous variant in B4GALT7 gene with a founder effect in La Réunion population. Proteoglycans (PG) that are a major component of the extracellular matrix, are composed of a core protein connected to a glycosaminoglycans side chain via a tetrasaccharide linker region. B4GALT7 encodes galactosyltransferase I, one of the enzymes involved in the biosynthesis of the linker region. Conditions caused by pathogenic biallelic variants in genes implicated in the synthesis of the tetrasaccharide linker of PG are known as linkeropathies. Prenatal features are rarely described in this group of chondrodysplasias. We present a series of 12 unpublished patients having LRS and describe the perinatal phenotype. All the patients had a prenatal growth restriction with brevity of limbs. The other features revealed by ultrasounds were increased nuchal translucency at 10-12 weeks of gestation (50 %), feet abnormalities (clubfeet or metatarsus varus) (25 %), dislocation affecting at least one large joint (elbow, knee, wrist) (25 %). Bilateral bowing of femora was noted for two fetuses. Fibular hypertrophy was noted for one fetus. Prenatal helical computed tomography (CT) performed in three pregnancies showed additional data such as bowing of the forearm bones, proximal radio-ulnar synostosis, or dislocation of large joints. Prenatal sonographic and helical CT findings led to the prenatal diagnosis of LRS in four patients. We confirm that the neonatal clinical picture of LRS has an important overlap with that reported in patients with B4GALT7 deficiency outside La Réunion Island and other linkeropathies. The core of the phenotypic spectrum combines low birth height, micromelia, hypermobility, dislocation of at least one large joint, facial features with prominent eyes, microstomia, depressed nasal bridge, and midface hypoplasia. Other clinical features include clubfeet (33%), bifid thumb in one patient, and cardiac abnormalities in two patients. Radiological findings include radio-ulnar synostosis (75%), metaphyseal flaring, precocious carpal ossification, and a Swedish key appearance of the proximal femora. Finally, we also report radiological features rarely described in B4GALT7-linkeropathies, including bowing of the femora and fibular hypertrophy. Our results confirm the phenotypic continuum of LRS within linkeropathies with some additional findings, including a high frequency of clubfeet usually described in B3GALT6-linkeropathies, the presence of congenital heart diseases usually described in B3GAT3-linkeropathies, and a high frequency of metaphyseal flaring usually reported in B3GALT6 or XITLT1-linkeropathies. This is the first study that describes the perinatal phenotype in a cohort of patients with LRS. This study can help improve the prenatal diagnosis of the linkeropathies and add this group of conditions to the differential diagnosis of chondrodysplasias with multiple dislocations. In view of the founder effect for LRS in La Réunion Island, this disease should be suspected in fetuses with growth restriction and micromelia. Thus in case of LOH which include B4GALT7 identified in SNP-array, we recommend performing a targeted Sanger sequencing for the recurrent mutation c.808C > T; p. (Arg270Cys).
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Affiliation(s)
- Jean-Luc Alessandri
- Service de Génétique Médicale, Centre Hospitalier Universitaire de La Réunion, La Réunion, France; Centre Pluridisciplinaire de Diagnostic Prénatal, Centre Hospitalier Universitaire de La Réunion, La Réunion, France.
| | - Tristan Celse
- Service de Génétique Médicale, Centre Hospitalier Universitaire de La Réunion, La Réunion, France
| | - Marta Spodenkiewicz
- Service de Génétique Médicale, Centre Hospitalier Universitaire de La Réunion, La Réunion, France; Centre Pluridisciplinaire de Diagnostic Prénatal, Centre Hospitalier Universitaire de La Réunion, La Réunion, France
| | - Anais Calaya
- Service de Génétique Médicale, Centre Hospitalier Universitaire de La Réunion, La Réunion, France
| | - Coralie Dumont
- Centre Pluridisciplinaire de Diagnostic Prénatal, Centre Hospitalier Universitaire de La Réunion, La Réunion, France
| | - Marie-Line Jacquemont
- Service de Génétique Médicale, Département de Pédiatrie, CHU Sainte-Justine, Québec, Canada
| | - Bénédicte Bertaut-Nativel
- Registre des Malformations Congénitales de La Réunion, Centre Hospitalier Universitaire de La Réunion, La Réunion, France
| | - Brahim Boumahni
- Centre Pluridisciplinaire de Diagnostic Prénatal, Centre Hospitalier Universitaire de La Réunion, La Réunion, France
| | - Mathilde Rémy
- Centre Pluridisciplinaire de Diagnostic Prénatal, Centre Hospitalier Universitaire de La Réunion, La Réunion, France
| | - Fanny Ferroul
- Service de Génétique Médicale, Centre Hospitalier Universitaire de La Réunion, La Réunion, France
| | - Suzie Guilly
- Service de Génétique Médicale, Centre Hospitalier Universitaire de La Réunion, La Réunion, France
| | - Thomas Huby
- Service de Génétique Médicale, Centre Hospitalier Universitaire de La Réunion, La Réunion, France
| | - Mireille Irabé
- Service de Génétique Médicale, Centre Hospitalier Universitaire de La Réunion, La Réunion, France
| | - Tiffany Laurens
- Service de Génétique Médicale, Centre Hospitalier Universitaire de La Réunion, La Réunion, France
| | - Patrick Munier
- Service de Génétique Médicale, Centre Hospitalier Universitaire de La Réunion, La Réunion, France
| | - Godelieve Morel
- Service de Génétique Médicale, Centre Hospitalier Universitaire de La Réunion, La Réunion, France
| | - Frédérique Payet
- Service de Génétique Médicale, Centre Hospitalier Universitaire de La Réunion, La Réunion, France; Centre Pluridisciplinaire de Diagnostic Prénatal, Centre Hospitalier Universitaire de La Réunion, La Réunion, France
| | - Hanitra Randrianaivo
- Service de Génétique Médicale, Centre Hospitalier Universitaire de La Réunion, La Réunion, France; Registre des Malformations Congénitales de La Réunion, Centre Hospitalier Universitaire de La Réunion, La Réunion, France
| | - Bérénice Doray
- Service de Génétique Médicale, Centre Hospitalier Universitaire de La Réunion, La Réunion, France
| | - Jessica Dospeux
- Centre Pluridisciplinaire de Diagnostic Prénatal, Centre Hospitalier Universitaire de La Réunion, La Réunion, France
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Abstract
Larsen syndrome is a rare inherited disorder of collagen formation with multiple joint dislocations, cardiac abnormalities, short stature, talipes equinovarus, short and broad fingertips, spatula-like thumbs, supernumerary ossification center in the calcaneus, hearing loss, neurologic impairment, cryptorchidism, and characteristic craniofacial abnormalities. The sonographic prenatal findings in a case of Larsen syndrome at 26 weeks’ gestation, which demonstrated joint dislocations, hypertelorism, frontal bossing, micrognathia, and upper and lower limb shortening and confirmed at both 29 and 30 weeks’ gestation, are presented and discussed. When evaluating patients with a positive family history of Larsen syndrome, sonographers should carefully scan and meticulously assess the fetal extremities for signs of dislocation and the face for signs of flat features, hypertelorism, micrognathia, and depressed nasal bridge, distinctive features of the syndrome.
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Affiliation(s)
- Hamad H. Ghazle
- From the Rochester Institute of Technology, Diagnostic Medical Sonography Program, Rochester, NY, USA
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Shih JC, Peng SS, Hsiao SM, Wang JH, Shyu MK, Lee CN, Hsieh FJ. Three-dimensional ultrasound diagnosis of Larsen syndrome with further characterization of neurological sequelae. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2004; 24:89-93. [PMID: 15229923 DOI: 10.1002/uog.1080] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Larsen syndrome consists of skeletal dysplasia with multiple joint dislocations and a characteristic facies. The basis of this abnormality is a generalized mesenchymal disorder involving connective tissues. We describe our findings in a woman who was referred at 28 weeks' gestation due to multiple fetal anomalies suspected initially at an 18-week ultrasound examination. On three-dimensional (3D) ultrasound we found the fetus had bilateral genu recurvatum. Further 3D examination at 36 weeks confirmed the lower limb anomaly and revealed facial anomalies that led to the diagnosis of Larsen syndrome. An elective Cesarean section was performed at 38 weeks' gestation to minimize neurological sequelae. Magnetic resonance imaging was performed postnatally and showed pachygyria, colpocephaly and agenesis of the corpus callosum. In this case, 3D ultrasound facilitated the prenatal diagnosis of Larsen syndrome. A careful prenatal investigation for other associated anomalies such as those of the cardiovascular or neurological systems is warranted with this diagnosis. These associated lesions are likely to have a greater impact on prognosis than the classic symptoms of Larsen syndrome and a collaborative approach is necessary to optimize delivery and postnatal management of an affected fetus.
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Affiliation(s)
- J C Shih
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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