Genetics of kidney disorders in Phelan-McDermid syndrome: evidence from 357 registry participants

BACKGROUND

Phelan-McDermid syndrome (PMS) is a rare genetic disorder caused by SHANK3 pathogenic variants or chromosomal rearrangements affecting the chromosome 22q13 region. Previous research found that kidney disorders, primarily congenital anomalies of the kidney and urinary tract, are common in people with PMS, yet research into candidate genes has been hampered by small study sizes and lack of attention to these problems.

METHODS

We used a cohort of 357 people from the Phelan-McDermid Syndrome Foundation International Registry to investigate the prevalence of kidney disorders in PMS using a cross-sectional design and to identify 22q13 genes contributing to these disorders.

RESULTS

Kidney disorders reported included vesicoureteral reflux (n = 37), hydronephrosis (n = 36), dysplastic kidneys (n = 19), increased kidney size (n = 19), polycystic kidneys (15 cases), and kidney stones (n = 4). Out of 315 subjects with a 22q13 deletion, 101 (32%) had at least one kidney disorder, while only one out of 42 (2%) individuals with a SHANK3 pathogenic variant had a kidney disorder (increased kidney size). We identified two genomic regions that were significantly associated with having a kidney disorder with the peak associations observed near positions approximately 5 Mb and 400 Kb from the telomere.

CONCLUSIONS

The candidate genes for kidney disorders include FBLN1, WNT7B, UPK3A, CELSR1, and PLXNB2. This study demonstrates the utility of patient registries for uncovering genetic contributions to rare diseases. Future work should focus on functional studies for these genes to assess their potential pathogenic contribution to the different subsets of kidney disorders.

Expression of hormone receptors, cathepsin D, and HER-2/neu oncoprotein in normal colon and colonic disease

BACKGROUND

Chronic ulcerative colitis and familial adenomatous polyposis are associated with an increased risk of colorectal carcinoma. Currently, there are no reliable methods to assess carcinoma risk.

METHODS

Several prognostic factors known to be useful in breast carcinoma were determined in 102 specimens of colonic mucosa from 38 patients: 22 specimens from "normal," non-neoplastic colon, 49 from chronic ulcerative colitis, 10 from Crohn's colitis, 14 from familial adenomatous polyposis, four from mucosa adjacent to carcinoma, and three from colon carcinoma. Expression of estrogen receptor, progestin receptor, epidermal growth factor receptor, HER-2/neu (c-erb B-2) oncoprotein, and cathepsin D were determined.

RESULTS

Epidermal growth factor receptor expression was higher in chronic ulcerative colitis, Crohn's colitis, familial adenomatous polyposis, and colon carcinoma and varied with location within the colon for chronic ulcerative colitis, Crohn's colitis, and familial adenomatous polyposis. Epidermal growth factor receptor expression in mucosa adjacent to carcinoma was similar to that in "normal" colon.

CONCLUSION

Further analyses are needed to determine which parameters are related to and possibly predictive of increased carcinoma risk.

Thermography: a technique for subclinical diagnosis of osteoarthritis

Thermographic and radiographic evaluations of the tarsus (hock) were done on 20 Standardbred racehorses before and after exercise at three consecutive 6-week intervals. All horses were from the same stable and given the same care and training under identical schedules and conditions. Normal thermographic patterns were established before and after exercise. These patterns corresponded to the underlying tarsal vasculature. Postexercise thermal patterns indicated a warming trend, and the increases were uniform. Abnormal thermal patterns were more localized and did not conform to the normal underlying vascular distribution. Five of the 20 horses trained successfully and competed professionally, with 1 of the 5 showing abnormal thermographic changes. Four horses were too slow to race, and all of these had abnormal thermographic changes of their tarsi. The medial aspect of the right tarsus was more commonly involved than the lateral in these horses. Only one horse was clinically lame and exhibited thermal increases, as well as radiographic changes in the right tarsus. The remaining horses were removed from training due to miscellaneous causes. It was believed that the four horses that failed to make minimum track times (for racing) suffered discomfort in their tarsi sufficient to impair performance. This problem was attributed to early subclinical inflammatory changes within the joints. Though difficult to recognize radiographically, these early changes were conspicuous as abnormal thermographic patterns typical of inflammation.

Thermographic diagnosis of Horner's syndrome in the horse

Lateral and frontal thermographic patterns of the head of normal horses before and after exercise were characterized to aid the diagnosis of diseases of the head. Surgical induction of Horner's syndrome was done in four horses by isolation and transection of the vagosympathetic trunk. One clinical case and the surgically induced cases of Horner's syndrome were evaluated clinically. Thermographic findings of the clinical case were similar to the experimental cases.

Thermography in the diagnosis of inflammatory processes in the horse

To evaluate the use of thermography in equine medicine, a three-phase study was conducted. In the first phase, six horses were examined thermographically, before and after exercise, to determine a normal thermal pattern. In the second phase, nine horses with acute and chronic inflammatory processes were examined thermographically. In the third phase, thermography was used to evaluate the effectiveness of anti-inflammatory drugs on chemically induced inflammatory reactions. All normal horses tested had similar infrared emission patterns. There was a high degree of symmetry between right and left and between front (dorsal) to rear (palmar, plantar) in the legs distal to the carpus and the tarsus. The warmer areas of the thermogram tended to follow major vascular structures. The coronary band was the warmest area of the leg. Heat increase due to exercise did not substantially alter the normal thermographic pattern. Use of thermography in clinical cases successfully detected a subluxation of the third lumbar vertebra, a subsolar abscess, alveolar periostitis and abscess, laminitis, serous arthritis of the femoropatellar joint, and tendonitis. Thermography was effective in quantitative and qualitative evaluation of anti-inflammatory compounds in the treatment of chemically induced inflammation.