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Rochmah YS, Harumsari S, Christiono S, Hutami IR, Fatimah-Muis S, Faradz SMH. Analysis of Consanguinity as Risk Factor of Nonsyndromic Cleft Lips with or without Palate. Eur J Dent 2023. [PMID: 37995730 DOI: 10.1055/s-0043-1774334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVES The etiologies of nonsyndromic cleft lips with or without palate (NS CL/P) are multifactorial, which include consanguineous marriages. The incidence of NS CL/P is relatively high in Indonesia notably in one of Indonesia's tribes whose members frequently marry close cousins. Thus, the purpose of this study is to analysis consanguinity as risk factor of NS CL/P in Sasak tribe, East Lombok, Indonesia MATERIALS AND METHODS: An observational analysis was made of a collected database of NS CL/P patients treated in social services in regency hospital of Dr. Soejono Selong, East Lombok, Indonesia. Demographic data such as age, gender, address (urban/rural), parent's education, presence or absence of consanguinity, type of clefts, and a three-generation pedigree were collected by interview and hospital medical record. Before analysis, patient information was anonymized and deidentified. From 2016 to 2018, each of 100 cleft and normal subjects with their Sasak parent were audited. The risk factors were analyzed statistically using odds ratio (OR) and chi-squared test. RESULTS Consanguineous marriages identified 54 cases (54%), and 10 cases (10%) out of a total each 100 NS CL/P and controls, respectively. The majority of consanguinity (53.7%) was discovered in marriages between first cousins. NS CL/P cases were statistically linked (p = 0.00) with consanguineous marriages (OR: 10; 95% confidence interval: 1.6-3.1); in which the most prevalent case is unilateral cleft lips. CONCLUSION Consanguineous marriage increases the risk of NS CL/P in Sasak tribe, East Lombok, Indonesia. The development of strategies to educate communities on the impacts of culture-consanguineous marriage is required. The genetic inheritance from their ancestor may be responsible for the increased incidence of NS CL/P.
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Affiliation(s)
- Yayun Siti Rochmah
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Universitas Islam Sultan Agung, Semarang, Indonesia
| | - Stefani Harumsari
- Department of Medical Biology, Faculty of Medicine, Universitas Islam Sultan Agung, Semarang, Indonesia
| | - Sandy Christiono
- Department of Pediatric Dentistry, Faculty of Dentistry, Universitas Islam Sultan Agung, Semarang, Indonesia
| | - Islamy Rahma Hutami
- Department of Orthodontics, Faculty of Dentistry, Universitas Islam Sultan Agung, Semarang, Indonesia
| | - Siti Fatimah-Muis
- Department of Nutrition, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
| | - Sultana M H Faradz
- Center for Biomedical Research (CEBIOR), Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
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Utari A, Faradz SMH, Ediati A, Rinne T, Ariani MD, Juniarto AZ, Drop SLS, van Herwaarden AE, Claahsen-van der Grinten HL. Corrigendum: Challenges in the treatment of late-identified untreated congenital adrenal hyperplasia due to CYP11B1 deficiency: Lessons from a developing country. Front Endocrinol (Lausanne) 2023; 14:1210892. [PMID: 37214254 PMCID: PMC10193252 DOI: 10.3389/fendo.2023.1210892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 05/24/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fendo.2022.1015973.].
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Affiliation(s)
- Agustini Utari
- Center for Biomedical Research (CEBIOR), Faculty of Medicine, Diponegoro University, Semarang, Indonesia
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Sultana M. H. Faradz
- Center for Biomedical Research (CEBIOR), Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Annastasia Ediati
- Center for Biomedical Research (CEBIOR), Faculty of Medicine, Diponegoro University, Semarang, Indonesia
- Faculty of Psychology, Diponegoro University, Semarang, Indonesia
| | - Tuula Rinne
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, Netherlands
| | - Mahayu Dewi Ariani
- Center for Biomedical Research (CEBIOR), Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Achmad Zulfa Juniarto
- Center for Biomedical Research (CEBIOR), Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Stenvert L. S. Drop
- Division of Pediatric Endocrinology, Sophia Children’s Hospital and Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Hedi L. Claahsen-van der Grinten
- Division of Pediatric Endocrinology, Department of Pediatrics, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, Netherlands
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Waaijers S, Utari A, van der Doelen RHA, Faradz SMH, Hensen-Lodewijk R, Olthaar AJ, Geutjes PJ, Sweep FC, Claahsen-van der Grinten HL, van Herwaarden AE. Measuring steroids in hair opens up possibilities to identify congenital adrenal hyperplasia in developing countries. Clin Endocrinol (Oxf) 2023; 98:41-48. [PMID: 35514026 PMCID: PMC10084416 DOI: 10.1111/cen.14754] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/16/2022] [Accepted: 04/25/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Patients with congenital adrenal hyperplasia (CAH) in developing countries have limited access to appropriate laboratory facilities for diagnosis and follow-up. The aim of this study is to evaluate steroid measurement in hair as a diagnostic tool to identify and monitor CAH in these patients. DESIGN A method was developed to measure steroids in hair, the stability of steroids in hair was assessed, and the concentration range in healthy volunteers was determined. Hair samples of patients, before and after starting therapy, were transported at ambient temperature to The Netherlands for analysis. PATIENTS Twenty-two Indonesian CAH patients and 84 healthy volunteers participated. MEASUREMENTS Cortisol, 17-hydroxyprogesterone (17OHP), androstenedione, and testosterone in hair were measured by liquid chromatography with tandem mass spectrometry. RESULTS Steroids in hair could be measured and remained stable (<4.9% deviation) for at least 3 weeks at 4°C and 30°C. In each of the untreated patients, hair concentrations of 17OHP (9.43-1135 pmol/g), androstenedione (36.1-432 pmol/g), and testosterone (2.85-69.2 pmol/g) were all above the upper limit of the corresponding range in healthy volunteers; 5.5 pmol/g, 13 pmol/g, and 1.8 pmol/g, respectively. After starting glucocorticoid treatment, the steroid concentrations in the hair of CAH patients decreased significantly for androstenedione (73%) and testosterone (59%) after 6 months. CONCLUSIONS CAH could be confirmed in Indonesian patients based on the concentration of 17OHP, androstenedione, and testosterone in hair, and a treatment effect was observed. These findings open up opportunities to diagnose and/or monitor CAH in developing countries with a simple noninvasive technique.
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Affiliation(s)
- Selma Waaijers
- Department of Laboratory Medicine, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Agustini Utari
- Division of Human Genetics, Center for Biomedical Research (CEBIOR), Faculty of Medicine Diponegoro University, Semarang, Indonesia
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine Diponegoro University, Semarang, Indonesia
| | - Rick H A van der Doelen
- Department of Laboratory Medicine, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Sultana M H Faradz
- Division of Human Genetics, Center for Biomedical Research (CEBIOR), Faculty of Medicine Diponegoro University, Semarang, Indonesia
| | - Renate Hensen-Lodewijk
- Department of Laboratory Medicine, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Andre J Olthaar
- Department of Laboratory Medicine, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Paul J Geutjes
- Department of Laboratory Medicine, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Fred C Sweep
- Department of Laboratory Medicine, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Hedi L Claahsen-van der Grinten
- Department of Pediatrics, Radboud University Medical Center, Amalia Children's Hospital, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Antonius E van Herwaarden
- Department of Laboratory Medicine, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
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Temba GS, Vadaq N, Wan J, Kullaya V, Huskens D, Pecht T, Jaeger M, Boahen CK, Matzaraki V, Broeders W, Joosten LAB, Faradz SMH, Kibiki G, Middeldorp S, Cavalieri D, Lionetti P, de Groot PG, Schultze JL, Netea MG, Kumar V, de Laat B, Mmbaga BT, van der Ven AJ, Roest M, de Mast Q. Differences in thrombin and plasmin generation potential between East African and Western European adults: The role of genetic and non-genetic factors. J Thromb Haemost 2022; 20:1089-1105. [PMID: 35102686 PMCID: PMC9305795 DOI: 10.1111/jth.15657] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Geographic variability in coagulation across populations and their determinants are poorly understood. OBJECTIVE To compare thrombin (TG) and plasmin (PG) generation parameters between healthy Tanzanian and Dutch individuals, and to study associations with inflammation and different genetic, host and environmental factors. METHODS TG and PG parameters were measured in 313 Tanzanians of African descent living in Tanzania and 392 Dutch of European descent living in the Netherlands and related to results of a dietary questionnaire, circulating inflammatory markers, genotyping, and plasma metabolomics. RESULTS Tanzanians exhibited an enhanced TG and PG capacity, compared to Dutch participants. A higher proportion of Tanzanians had a TG value in the upper quartile with a PG value in the lower/middle quartile, suggesting a relative pro-coagulant state. Tanzanians also displayed an increased normalized thrombomodulin sensitivity ratio, suggesting reduced sensitivity to protein C. In Tanzanians, PG parameters (lag time and TTP) were associated with seasonality and food-derived plasma metabolites. The Tanzanians had higher concentrations of pro-inflammatory cytokines, which correlated strongly with TG and PG parameters. There was limited overlap in genetic variation associated with TG and PG parameters between the two cohorts. Pathway analysis of genetic variants in the Tanzanian cohort revealed multiple immune pathways that were enriched with TG and PG traits, confirming the importance of co-regulation between coagulation and inflammation. CONCLUSIONS Tanzanians have an enhanced TG and PG potential compared to Dutch individuals, which may relate to differences in inflammation, genetics and diet. These observations highlight the importance of better understanding of the geographic variability in coagulation across populations.
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Affiliation(s)
- Godfrey S. Temba
- Department of Internal MedicineRadboudumc Center for Infectious DiseasesRadboud Institute of Health Science (RIHS)Radboud university medical centerNijmegenthe Netherlands
- Department of Medical Biochemistry and Molecular BiologyKilimanjaro Christian Medical University College (KCMUCo)MoshiTanzania
| | - Nadira Vadaq
- Department of Internal MedicineRadboudumc Center for Infectious DiseasesRadboud Institute of Health Science (RIHS)Radboud university medical centerNijmegenthe Netherlands
- Center for Tropical and Infectious Diseases (CENTRID)Faculty of MedicineDr. Kariadi HospitalDiponegoro UniversitySemarangIndonesia
| | - Jun Wan
- Synapse Research InstituteCardiovascular Research Institute MaastrichtMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Vesla Kullaya
- Department of Medical Biochemistry and Molecular BiologyKilimanjaro Christian Medical University College (KCMUCo)MoshiTanzania
- Kilimanjaro Clinical Research InstituteKilimanjaro Christian Medical CenterMoshiTanzania
| | - Dana Huskens
- Synapse Research InstituteCardiovascular Research Institute MaastrichtMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Tal Pecht
- Department for Genomics and ImmunoregulationLife & Medical Sciences (LIMES) InstituteUniversity of BonnBonnGermany
- Systems MedicineGerman Center for Neurodegenerative Diseases (DZNE)BonnGermany
| | - Martin Jaeger
- Department of Internal MedicineRadboudumc Center for Infectious DiseasesRadboud Institute of Health Science (RIHS)Radboud university medical centerNijmegenthe Netherlands
| | - Collins K. Boahen
- Department of Internal MedicineRadboudumc Center for Infectious DiseasesRadboud Institute of Health Science (RIHS)Radboud university medical centerNijmegenthe Netherlands
| | - Vasiliki Matzaraki
- Department of Internal MedicineRadboudumc Center for Infectious DiseasesRadboud Institute of Health Science (RIHS)Radboud university medical centerNijmegenthe Netherlands
| | - Wieteke Broeders
- Department of Internal MedicineRadboudumc Center for Infectious DiseasesRadboud Institute of Health Science (RIHS)Radboud university medical centerNijmegenthe Netherlands
| | - Leo A. B. Joosten
- Department of Internal MedicineRadboudumc Center for Infectious DiseasesRadboud Institute of Health Science (RIHS)Radboud university medical centerNijmegenthe Netherlands
| | - Sultana M. H. Faradz
- Division of Human GeneticsCenter for Biomedical Research (CEBIOR)Faculty of MedicineDiponegoro University/Diponegoro National HospitalSemarangIndonesia
| | - Gibson Kibiki
- Kilimanjaro Clinical Research InstituteKilimanjaro Christian Medical CenterMoshiTanzania
| | - Saskia Middeldorp
- Department of Internal MedicineRadboud Institute of Health Science (RIHS)Radboud university medical centerNijmegenthe Netherlands
| | | | - Paolo Lionetti
- Departement NEUROFARBAMeyer Children's HospitalUniversity of Florence – Gastroenterology and Nutrition UnitFlorenceItaly
| | - Philip G. de Groot
- Synapse Research InstituteCardiovascular Research Institute MaastrichtMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Joachim L. Schultze
- Department for Genomics and ImmunoregulationLife & Medical Sciences (LIMES) InstituteUniversity of BonnBonnGermany
- Systems MedicineGerman Center for Neurodegenerative Diseases (DZNE)BonnGermany
- PRECISE Platform for Single Cell Genomics and EpigenomicsGerman Center for Neurodegenerative Diseases (DZNE) and University of BonnBonnGermany
| | - Mihai G. Netea
- Department of Internal MedicineRadboudumc Center for Infectious DiseasesRadboud Institute of Health Science (RIHS)Radboud university medical centerNijmegenthe Netherlands
- Department for Immunology and MetabolismLife & Medical Sciences (LIMES) InstituteUniversity of BonnBonnGermany
| | - Vinod Kumar
- Department of Internal MedicineRadboudumc Center for Infectious DiseasesRadboud Institute of Health Science (RIHS)Radboud university medical centerNijmegenthe Netherlands
- Department of GeneticsUniversity Medical Centre GroningenUniversity of GroningenGroningenthe Netherlands
| | - Bas de Laat
- Synapse Research InstituteCardiovascular Research Institute MaastrichtMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Blandina T. Mmbaga
- Kilimanjaro Clinical Research InstituteKilimanjaro Christian Medical CenterMoshiTanzania
- Department of PaediatricsKilimanjaro Christian Medical University College (KCMUCo)MoshiTanzania
| | - Andre J. van der Ven
- Department of Internal MedicineRadboudumc Center for Infectious DiseasesRadboud Institute of Health Science (RIHS)Radboud university medical centerNijmegenthe Netherlands
| | - Mark Roest
- Synapse Research InstituteCardiovascular Research Institute MaastrichtMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Quirijn de Mast
- Department of Internal MedicineRadboudumc Center for Infectious DiseasesRadboud Institute of Health Science (RIHS)Radboud university medical centerNijmegenthe Netherlands
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Utari A, Faradz SMH, Ediati A, Rinne T, Ariani MD, Juniarto AZ, Drop SLS, van Herwaarden AE, Claahsen-van der Grinten HL. Challenges in the treatment of late-identified untreated congenital adrenal hyperplasia due to CYP11B1 deficiency: Lessons from a developing country. Front Endocrinol (Lausanne) 2022; 13:1015973. [PMID: 36589846 PMCID: PMC9797803 DOI: 10.3389/fendo.2022.1015973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Congenital Adrenal Hyperplasia (CAH) due to CYP11B1 is a rare autosomal recessive adrenal disorder that causes a decrease in cortisol production and accumulation of adrenal androgens and steroid precursors with mineralocorticoid activity. Clinical manifestations include cortisol deficiency, ambiguous genitalia in females (differences of sex development (DSD)), and hypertension. Medical treatment recommendations are well defined, consisting of glucocorticoid treatment to substitute glucocorticoid deficiency and consequently normalize adrenal androgen and precursors levels. Current guidelines also emphasize the need for specialized multidisciplinary DSD teams and psychosocial support. In many developing countries, care for DSD patients, especially when caused by an adrenal disease, is challenging due to the lack of infrastructure, knowledge, and medication. OBJECTIVE The study aims to report the conflicting decision-making process of medical treatment and sex assignment in late-identified CAH patients in developing countries. METHODS We describe the clinical and biochemical findings and the psychological assessment of five affected but untreated family members with CAH due to CYP11B1 deficiency. RESULTS All patients had a 46,XX karyotype, ambiguous genitalia, low cortisol levels, and hypertension. Two identified as males, two as females, and one had undecided gender. The patients were counselled that refusing treatment will lead to infertility and the potential risk of developing Addisonian crisis and severe hypertension. However, all 46,XX CAH males refused treatment with glucocorticoids due to the expected lowering of adrenal androgens as their main source of testosterone. None of the patients developed Addisonian crisis, probably due to some residual cortisol activity and glucocorticoid activity of elevated adrenal steroid precursors. CONCLUSION Medical treatment and sex assignment in late-identified 46,XX CAH patients in Indonesia may often depend on local and cultural factors. The management of DSD conditions may have to be individualized and integrated into the psychological and social context of the affected family.
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Affiliation(s)
- Agustini Utari
- Center for Biomedical Research (CEBIOR), Faculty of Medicine, Diponegoro University, Semarang, Indonesia
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
- *Correspondence: Agustini Utari,
| | - Sultana M. H. Faradz
- Center for Biomedical Research (CEBIOR), Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Annastasia Ediati
- Center for Biomedical Research (CEBIOR), Faculty of Medicine, Diponegoro University, Semarang, Indonesia
- Faculty of Psychology, Diponegoro University, Semarang, Indonesia
| | - Tuula Rinne
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, Netherlands
| | - Mahayu Dewi Ariani
- Center for Biomedical Research (CEBIOR), Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Achmad Zulfa Juniarto
- Center for Biomedical Research (CEBIOR), Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Stenvert L. S. Drop
- Division of Pediatric Endocrinology, Sophia Children’s Hospital and Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Hedi L. Claahsen-van der Grinten
- Division of Pediatric Endocrinology, Department of Pediatrics, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, Netherlands
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Listyasari NA, Juniarto AZ, Robevska G, Ayers KL, Sinclair AH, Faradz SMH. Analysis of the androgen receptor (AR) gene in a cohort of Indonesian undermasculinized 46, XY DSD patients. Egypt J Med Hum Genet 2021. [DOI: 10.1186/s43042-021-00134-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Abstract
Background
Pathogenic variants in the androgen receptor (AR) gene located on chromosome Xq11-12, are known to cause varying degrees of undermasculinization in 46, XY individuals. The aim of this study was to investigate the frequency of pathogenic variants in the AR gene in a cohort of 46, XY undermasculinized individuals from Indonesia who were suspected of having androgen insensitivity syndrome (AIS). All patients with 46, XY DSD referred to our center between 1994 and 2019 were collected from our clinical database. All 46, XY DSD patients without a prior molecular diagnosis with an external masculinization score (EMS) ≤ 9 were included in this study. All exons and intron–exon boundaries of AR gene were analyzed using Sanger sequencing to identify pathogenic variants of the AR gene.
Results
A cohort of 75 undermasculinized patients were selected for the study. Direct Sanger sequencing of all eight exons of the AR gene led to a genetic diagnosis in 11 patients (14.67%). All of the variants identified (p.Arg841His; p.Ile604Asn; p.Val731Met; p.Pro672Ser; p.Gln739Arg; p.Ser302Glufs*3) have been previously reported in patients with AIS.
Conclusions
This is the first study in Indonesia that highlights the significance of molecular analysis in providing a definitive diagnosis of AIS for patients with 46, XY DSD undermasculinization. This is an uncommon finding in the Indonesian population presenting with 46, XY DSD undermasculinization. A genetic diagnosis allows optimal clinical management and genetic counseling for patients and their families. As 46, XY DSD can be caused by pathogenic variants in other genes involved in gonadal development and differentiation, further genetic analysis, such as whole exome sequencing, should be carried out on those patients that did not carry an AR variant.
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Sihombing NRB, Winarni TI, van Bokhoven H, van der Burgt I, de Leeuw N, Faradz SMH. Pathogenic variant in NFIX gene affecting three sisters due to paternal mosaicism. Am J Med Genet A 2020; 182:2731-2736. [PMID: 32945093 DOI: 10.1002/ajmg.a.61835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/14/2020] [Accepted: 06/25/2020] [Indexed: 12/26/2022]
Abstract
We present a family with three girls presenting similar dysmorphic features, including overgrowth, intellectual disability, macrocephaly, prominent forehead, midface retrusion, strabismus, and scoliosis. Both parents were unaffected, suggesting the presence of an autosomal recessive syndrome. Following exome sequencing, a heterozygous nonsense variant was identified in the NFIX gene in all three siblings. The father appeared to have a low-grade (7%) mosaicism for this variant in his blood. Previously, de novo pathogenic variants in NFIX have been identified in Marshall-Smith syndrome and Malan syndrome, which share distinctive phenotypic features shared with the patients of the present family. This case emphasizes the importance of further molecular analysis especially in familial cases, to exclude the possibility of parental mosaicism.
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Affiliation(s)
- Nydia Rena Benita Sihombing
- Doctoral Program of Medical and Health Sciences, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Tri Indah Winarni
- Division of Human Genetics, Center for Biomedical Research (CEBIOR), Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Hans van Bokhoven
- Department of Human Genetics, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ineke van der Burgt
- Department of Human Genetics, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nicole de Leeuw
- Department of Human Genetics, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sultana M H Faradz
- Division of Human Genetics, Center for Biomedical Research (CEBIOR), Faculty of Medicine, Diponegoro University, Semarang, Indonesia
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van den Bergen JA, Robevska G, Eggers S, Riedl S, Grover SR, Bergman PB, Kimber C, Jiwane A, Khan S, Krausz C, Raza J, Atta I, Davis SR, Ono M, Harley V, Faradz SMH, Sinclair AH, Ayers KL. Analysis of variants in GATA4 and FOG2/ZFPM2 demonstrates benign contribution to 46,XY disorders of sex development. Mol Genet Genomic Med 2020; 8:e1095. [PMID: 31962012 PMCID: PMC7057099 DOI: 10.1002/mgg3.1095] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/22/2019] [Indexed: 01/22/2023] Open
Abstract
Background GATA‐binding protein 4 (GATA4) and Friend of GATA 2 protein (FOG2, also known as ZFPM2) form a heterodimer complex that has been shown to influence transcription of genes in a number of developmental systems. Recent evidence has also shown these genes play a role in gonadal sexual differentiation in humans. Previously we identified four variants in GATA4 and an unexpectedly large number of variants in ZFPM2 in a cohort of individuals with 46,XY Differences/Disorders of Sex Development (DSD) (Eggers et al, Genome Biology, 2016; 17: 243). Method Here, we review variant curation and test the functional activity of GATA4 and ZFPM2 variants. We assess variant transcriptional activity on gonadal specific promoters (Sox9 and AMH) and variant protein–protein interactions. Results Our findings support that the majority of GATA4 and ZFPM2 variants we identified are benign in their contribution to 46,XY DSD. Indeed, only one variant, in the conserved N‐terminal zinc finger of GATA4, was considered pathogenic, with functional analysis confirming differences in its ability to regulate Sox9 and AMH and in protein interaction with ZFPM2. Conclusions Our study helps define the genetic factors contributing to 46,XY DSD and suggests that the majority of variants we identified in GATA4 and ZFPM2/FOG2 are not causative.
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Affiliation(s)
| | - Gorjana Robevska
- Genetics, Murdoch Children's Research Institute, Parkville, Vic., Australia
| | - Stefanie Eggers
- Research Genomics, Murdoch Children's Research Institute, Parkville, Vic., Australia
| | - Stefan Riedl
- St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria.,Paediatric Department, Medical University of Vienna, Vienna, Austria
| | - Sonia R Grover
- Genetics, Murdoch Children's Research Institute, Parkville, Vic., Australia.,Department of Paediatric and Adolescent Gynaecology, Royal Children's Hospital Melbourne, Parkville, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia
| | - Philip B Bergman
- Department of Paediatric Endocrinology and Diabetes, Monash Children's Hospital, Clayton, Vic., Australia.,Department of Paediatrics, Monash University, Clayton, Vic., Australia
| | - Chris Kimber
- Department of Paediatric Urology, Monash Children's Hospital, Clayton, Vic., Australia
| | - Ashish Jiwane
- Department of Urology, Sydney Children's Hospital Randwick, Randwick, NSW, Australia
| | - Sophy Khan
- Surgical Department, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Csilla Krausz
- Department of Experimental and Clinical Biomedical Sciences"Mario Serio", University of Florence, Firenze, Toscana, Italy
| | - Jamal Raza
- Paediatric Department, National Institute of Child Health, Karachi City, Sindh, Pakistan
| | - Irum Atta
- Paediatric Department, National Institute of Child Health, Karachi City, Sindh, Pakistan
| | - Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Makato Ono
- Department of Paediatrics, Tokyo Bay Urayasu Ichikawa Iryo Center, Urayasu, Chiba, Japan
| | - Vincent Harley
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Vic., Australia
| | - Sultana M H Faradz
- Division of Human Genetics, Centre for Biomedical Research Faculty of Medicine, Diponegoro University (FMDU), Semarang, Indonesia
| | - Andrew H Sinclair
- Genetics, Murdoch Children's Research Institute, Parkville, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia
| | - Katie L Ayers
- Genetics, Murdoch Children's Research Institute, Parkville, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia
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Engels M, Pijnenburg-Kleizen KJ, Utari A, Faradz SMH, Oude-Alink S, van Herwaarden AE, Span PN, Sweep FC, Claahsen-van der Grinten HL. Glucocorticoid Activity of Adrenal Steroid Precursors in Untreated Patients With Congenital Adrenal Hyperplasia. J Clin Endocrinol Metab 2019; 104:5065-5072. [PMID: 31090904 DOI: 10.1210/jc.2019-00547] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 05/09/2019] [Indexed: 02/13/2023]
Abstract
CONTEXT AND OBJECTIVE We describe the clinical features and biochemical characteristics of a unique population of severely affected untreated patients with congenital adrenal hyperplasia (CAH) from an Indonesian population with proven cortisol deficiency but without clinical signs of cortisol deficiency. We evaluated the in vitro glucocorticoid activity of all relevant adrenal steroid precursors occurring in patients with CAH. DESIGN Cross-sectional cohort study and translational research. INTERVENTION/MAIN OUTCOME MEASURES Adrenal steroid precursor concentrations before and 60 minutes after ACTH administration to 24 untreated patients with CAH (3 to 46 years) with proven cortisol deficiency (<500 nmol/L post-ACTH) measured by liquid chromatography-tandem mass spectrometry were compared with six control patients (Mann-Whitney U test). Glucocorticoid receptor (GR) activation was determined by dual-luciferase assays in human embryonic kidney cells transfected with the GR and exposed to increasing amounts of adrenal steroid precursors for 24 hours. RESULTS Blood concentrations of the steroid precursors 11-deoxycortisol (457 nmol/L, P = 0.003), 11-deoxycorticosterone (55 nmol/L, P = 0.003), 17-hydroxyprogesterone (610 nmol/L, P < 0.001), progesterone (29 nmol/L, P < 0.001), and 21-deoxycortisol (73 nmol/L) were strongly elevated compared with control subjects. The GR was activated with comparable potency to cortisol by corticosterone and 21-deoxycortisol or with 4 to 100 times lower potency by 11-hydroxyprogesterone, 11-deoxycortisol, aldosterone, 11-deoxycorticosterone, progesterone, and 17-hydroxyprogesterone. CONCLUSIONS We identified strongly elevated adrenal steroid precursor concentrations in blood from untreated patients with CAH and demonstrated glucocorticoid activity of these adrenal precursors in vitro, suggesting a possible role of these precursors in the clinical phenotype of these patients. Further studies are necessary to evaluate the role of these precursors in more detail.
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Affiliation(s)
- Manon Engels
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Amalia Children's Hospital, Department of Pediatrics, Nijmegen, Netherlands
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Department of Laboratory Medicine, Nijmegen, Netherlands
| | - Karijn J Pijnenburg-Kleizen
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Amalia Children's Hospital, Department of Pediatrics, Nijmegen, Netherlands
| | - Agustini Utari
- Division of Human Genetics, Center for Biomedical Research (CEBIOR), Faculty of Medicine Diponegoro University, Tembalang Semarang, Indonesia
- Division of Pediatric Endocrinology, department of Pediatrics, Faculty of Medicine Diponegoro University, Tembalang Semarang, Indonesia
| | - Sultana M H Faradz
- Division of Human Genetics, Center for Biomedical Research (CEBIOR), Faculty of Medicine Diponegoro University, Tembalang Semarang, Indonesia
- Division of Pediatric Endocrinology, department of Pediatrics, Faculty of Medicine Diponegoro University, Tembalang Semarang, Indonesia
| | - Sandra Oude-Alink
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Department of Laboratory Medicine, Nijmegen, Netherlands
| | - Antonius E van Herwaarden
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Department of Laboratory Medicine, Nijmegen, Netherlands
| | - Paul N Span
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Department of Laboratory Medicine, Nijmegen, Netherlands
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Department of Radiation Oncology, Radiotherapy & OncoImmunology Laboratory, Nijmegen, Netherlands
| | - Fred C Sweep
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Department of Laboratory Medicine, Nijmegen, Netherlands
| | - Hedi L Claahsen-van der Grinten
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Amalia Children's Hospital, Department of Pediatrics, Nijmegen, Netherlands
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10
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Cutiongco‐de la Paz EM, Chung BH, Faradz SMH, Thong M, David‐Padilla C, Lai PS, Lin S, Chen Y, Sura T, Laurino M. Training in clinical genetics and genetic counseling in Asia. Am J Med Genet 2019; 181:177-186. [DOI: 10.1002/ajmg.c.31703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/30/2019] [Accepted: 04/15/2019] [Indexed: 01/17/2023]
Affiliation(s)
| | - Brian Hon‐Yin Chung
- Department of Paediatrics and Adolescent MedicineThe University of Hong Kong Hong Kong Hong Kong
| | - Sultana M. H. Faradz
- Division Human Genetics, Center for Biomedical Research, Faculty of Medicine Diponegoro University Semarang Indonesia
| | - Meow‐Keong Thong
- Genetics & Metabolism Unit, Department of Paediatrics, Faculty of MedicineUniversity of Malaya Kuala Lumpur Malaysia
| | - Carmencita David‐Padilla
- Institute of Human GeneticsNational Institutes of Health, University of the Philippines Manila Manila Philippines
- Department of Pediatrics, College of MedicineUniversity of the Philippines Manila Manila Philippines
| | - Poh San Lai
- Department of Paediatrics, Yong Loo Lin School of MedicineNational University Singapore Singapore
| | - Shuan‐Pei Lin
- Division of Genetics and Metabolism, Department of PediatricsMackay Memorial Hospital Taipei Taiwan
| | - Yin‐Hsiu Chen
- Department of Medical Genetics and PediatricsNational Taiwan University Hospital Taipei Taiwan
| | - Thanyachai Sura
- Medical Genetics and Molecular Medicine, Ramathibodi Medical SchoolMahidol University Bangkok Thailand
| | - Mercy Laurino
- Department of Pediatrics, College of MedicineUniversity of the Philippines Manila Manila Philippines
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11
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Ayers K, van den Bergen J, Robevska G, Listyasari N, Raza J, Atta I, Riedl S, Rothacker K, Choong C, Faradz SMH, Sinclair A. Functional analysis of novel desert hedgehog gene variants improves the clinical interpretation of genomic data and provides a more accurate diagnosis for patients with 46,XY differences of sex development. J Med Genet 2019; 56:434-443. [PMID: 31018998 PMCID: PMC6591740 DOI: 10.1136/jmedgenet-2018-105893] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/09/2019] [Accepted: 01/15/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Desert hedgehog (DHH) gene variants are known to cause 46,XY differences/disorders of sex development (DSD). We have identified six patients with 46,XY DSD with seven novel DHH gene variants. Many of these variants were classified as variants of uncertain significance due to their heterozygosity or associated milder phenotype. To assess variant pathogenicity and to refine the spectrum of DSDs associated with this gene, we have carried out the first reported functional testing of DHH gene variant activity. METHODS A cell co-culture method was used to assess DHH variant induction of Hedgehog signalling in cultured Leydig cells. Protein expression and subcellular localisation were also assessed for DHH variants using western blot and immunofluorescence. RESULTS Our co-culture method provided a robust read-out of DHH gene variant activity, which correlated closely with patient phenotype severity. While biallelic DHH variants from patients with gonadal dysgenesis showed significant loss of activity, variants found as heterozygous in patients with milder phenotypes had no loss of activity when tested with a wild type allele. Taking these functional results into account improved clinical interpretation. CONCLUSION Our findings suggest heterozygous DHH gene variants are unlikely to cause DSD, reaffirming that DHH is an autosomal recessive cause of 46,XY gonadal dysgenesis. Functional characterisation of novel DHH variants improves variant interpretation, leading to greater confidence in patient reporting and clinical management.
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Affiliation(s)
- Katie Ayers
- Cell Biology, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | | | - Gorjana Robevska
- Cell Biology, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Nurin Listyasari
- Centre for Biomedical Research Faculty of Medicine Diponegoro University, Division of Human Genetics, Semarang, Indonesia
| | - Jamal Raza
- National Institute of Child Health, Karachi, Pakistan
| | - Irum Atta
- National Institute of Child Health, Karachi, Pakistan
| | - Stefan Riedl
- St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria.,Paediatric Department, Medical University of Vienna, Vienna, Austria
| | - Karen Rothacker
- Division of Pediatric Pulmology, Allergology and Endocrinology, Pediatric Department, Princess Margaret Hospital, Perth, Australia
| | - Catherine Choong
- Division of Pediatric Pulmology, Allergology and Endocrinology, Pediatric Department, Princess Margaret Hospital, Perth, Australia.,School of Paediatrics and Child Health, The University of Western Australia, Crawley, Australia
| | - Sultana M H Faradz
- Division of Human Genetics, Center for Biomedical Research, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Andrew Sinclair
- Cell Biology, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
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12
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Bouty A, Walton K, Listyasari NA, Robevska G, Van den Bergen J, Santosa A, Faradz SMH, Harrison C, Ayers KL, Sinclair AH. Functional Characterization of Two New Variants in the Bone Morphogenetic Protein 7 Prodomain in Two Pairs of Monozygotic Twins With Hypospadias. J Endocr Soc 2019; 3:814-824. [PMID: 30963139 PMCID: PMC6446891 DOI: 10.1210/js.2018-00333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/19/2019] [Indexed: 11/29/2022] Open
Abstract
Context Variants in bone morphogenetic protein 7 (BMP7) have been reported in patients with hypospadias. Here we report and analyze two variants in the BMP7 prodomain in monozygotic twins with hypospadias. Materials and Methods Patients with hypospadias were prospectively recruited. After informed consent was obtained, DNA was extracted from blood. The coding regions of 1034 genes [including 64 known diagnostic genes and candidate genes for disorder/difference of sex development (DSD)] were sequenced using a targeted capture approach (HaloPlex, Agilent, Santa Clara, CA), combined with massively parallel sequencing. The resulting variants were filtered for rarity in the general population (<1%) and in our screen. Quality, depth of the reads, and predicted pathogenicity were also considered. The consequences of the identified mutations on BMP7 expression was determined by Western blot analysis on culture media from transfected cells, and activity measured using a SMAD 1/5-responsiveness luciferase assay. Results We analyzed DNA from 46 patients with hypospadias. Two variants in BMP7 were identified in two pairs of monozygotic concordant twins exhibiting proximal hypospadias. Both variants are heterozygous, nonsynonymous, and affect highly conserved amino acids in the prodomain of BMP7 in regions predicted to be important for BMP7 assembly/folding. Functional analyses demonstrated that both variants disrupt BMP7 synthesis or secretion. Conclusion Through our targeted DSD panel we have identified two variants in the prodomain of BMP7 in hypospadias. By decreasing BMP7 synthesis, these variants are likely to limit BMP7 bioavailability during closure of the urethral plate.Further analysis of patients with hypospadias may uncover additional variants that cause this DSD.
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Affiliation(s)
- Aurore Bouty
- Murdoch Children's Research Institute, Parkville, Australia.,Urology Department, Royal Children's Hospital, Parkville, Australia
| | - Kelly Walton
- Department of Physiology, Growth Factor Therapeutics Laboratory, Monash University, Clayton, Australia
| | | | | | | | - Ardy Santosa
- Urology Section, Department of Surgery, Dr Kariadi General Hospital, Semarang, Indonesia
| | - Sultana M H Faradz
- Centre for Biomedical Research, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Craig Harrison
- Department of Physiology, Growth Factor Therapeutics Laboratory, Monash University, Clayton, Australia
| | - Katie L Ayers
- Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Andrew H Sinclair
- Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
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13
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Tan VJ, Lian M, Faradz SMH, Winarni TI, Chong SS. A Single Common Assay for Robust and Rapid Fragile X Mental Retardation Syndrome Screening From Dried Blood Spots. Front Genet 2018; 9:582. [PMID: 30538724 PMCID: PMC6277581 DOI: 10.3389/fgene.2018.00582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 11/08/2018] [Indexed: 12/24/2022] Open
Abstract
Background:FMR1 CGG trinucleotide repeat hyper-expansions are observed in 99% of individuals with fragile X mental retardation syndrome (FXS). We evaluated the reliability of a rapid single-step gender-neutral molecular screen for FXS when performed on DNA isolated from dried blood spots. Methods: DNA was extracted from dried blood spots of 151 individuals with intellectual disability or autism spectrum disorder, whose FMR1 repeat genotypes are known. Dried blood spots were blinded prior to DNA extraction and analysis by triplet primed PCR (TP-PCR) and melt curve analysis (MCA). All expansion-positive and representative expansion-negative samples were also genotyped by fluorescent TP-PCR and capillary electrophoresis (CE) to confirm repeat expansion status. Results: Three males and 12 females were classified as expanded by TP-PCR MCA, and were subsequently sized by fluorescent TP-PCR CE. Two males and four females carried premutations, while one male and eight females carried full mutations. All 19 non-expanded samples that were sized were confirmed as carrying only normal alleles. Replicate analysis of representative expansion-positive samples yielded reproducible melt peak profiles. TP-PCR MCA classifications were completely concordant with FMR1 CGG repeat genotypes. Conclusion: TP-PCR MCA of dried blood spot DNA accurately and reliably identifies presence/absence of FMR1 CGG repeat expansions in both genders simultaneously. This strategy may be suitable for rapid high-throughput first-tier screening for fragile X syndrome.
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Affiliation(s)
- Vivienne J Tan
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mulias Lian
- Khoo Teck Puat - National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Sultana M H Faradz
- Division of Human Genetics, Center for Biomedical Research, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Tri I Winarni
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Khoo Teck Puat - National University Children's Medical Institute, National University Health System, Singapore, Singapore.,Division of Human Genetics, Center for Biomedical Research, Faculty of Medicine, Diponegoro University, Semarang, Indonesia.,Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore, Singapore
| | - Samuel S Chong
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Khoo Teck Puat - National University Children's Medical Institute, National University Health System, Singapore, Singapore.,Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore, Singapore
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14
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Barr JA, Tsai LP, Welch A, Faradz SMH, Lane-Krebs K, Howie V, Hillman W. Current practice for genetic counselling by nurses: An integrative review. Int J Nurs Pract 2018; 24:e12629. [PMID: 29462836 DOI: 10.1111/ijn.12629] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 11/29/2022]
Abstract
AIM To examine current practice of genetic counselling by nurses. BACKGROUND Recent debate argues that genetic counselling is a specialist advanced practice role, whilst others argue it is the role of all nurses. Current evidence is required to determine if genetic counselling could be included in all nurses' scope of practice. DESIGN Integrative literature review. DATA SOURCES A search of electronic databases (CINHAL, Medline, PubMed, Scopus), and reference lists published between January 2012 and March 2017, was undertaken. REVIEW METHODS Studies were critically appraised for methodological quality using the Critical Appraisal Skills Programme. Data from each study were extracted and categorized according to their primary findings. RESULTS The inclusion criteria were met in 10 studies. Main findings were identified: role of genetic counselling, current knowledge, need for further education, and client satisfaction with nurse genetic counsellors. CONCLUSION This paper concludes that some nurses do engage in genetic counselling, but how they engage is not consistent, nor is there consensus about what should be the scope of practice. Further investigation into credentialing, role recognition support and education for nurse genetic counselling are strongly recommended. As nurses are widely available, nurses can make a significant contribution to supporting those affected by genetic problems.
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Affiliation(s)
- Jennieffer A Barr
- School of Nursing, Midwifery, and Social Science, Central Queensland University, Brisbane, Australia
| | - Lily P Tsai
- School of Nursing, Midwifery, and Social Science, Central Queensland University, Brisbane, Australia
| | - Anthony Welch
- School of Nursing, Midwifery, and Social Science, Central Queensland University, Noosaville, Australia
| | | | - Katrina Lane-Krebs
- School of Nursing, Midwifery, and Social Science, Central Queensland University, Brisbane, Australia
| | - Virginia Howie
- School of Nursing, Midwifery, and Social Science, Central Queensland University, Noosaville, Australia
| | - Wendy Hillman
- School of Nursing, Midwifery, and Social Science, Central Queensland University, Rockhampton North, Australia
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15
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Ediati A, Verrips GHW, Juniarto AZ, Faradz SMH, Drop SLS, Dessens AB. Quality of Life in Late-Treated Patients With Disorders of Sex Development: Insights for Patient-Centered Care. Front Pediatr 2018; 6:434. [PMID: 30805316 PMCID: PMC6371023 DOI: 10.3389/fped.2018.00434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 12/28/2018] [Indexed: 11/23/2022] Open
Abstract
Background: Patients with a disorder of sex development (DSD) are born with atypical genitals or may develop atypical genitals and atypical body appearance, if left untreated. Health related quality of life (HRQoL) was assessed in Indonesian patients to whom diagnostic procedures and medical intervention had been delayed. Method: Comparison of 118 patients born with DSD, aged 6-41 years (60 children, 24 adolescents, and 34 adults) and 118 healthy control subjects matched for gender, age, and residential setting. HRQoL was measured using a translation of the TACQOL/TAAQOL. Results: According to parental and children's report, children with DSD reported more problems in social functioning and had less positive moods. Girls, in particular, reported problems in cognitive functioning. Adult patients reported more depressive moods, especially women, who reported more anger. No differences were found between in the adolescent groups. Conclusion: The data suggest that Indonesian children with DSD experienced more problems in social contact than non-affected Indonesian children, whereas Indonesian adults with DSD suffered from negative emotions more often than non-affected Indonesians. These findings on HRQoL are in line with findings on emotional functioning.
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Affiliation(s)
- Annastasia Ediati
- Faculty of Psychology, Diponegoro University, Semarang, Indonesia.,Faculty of Medicine, Center for Biomedical Research, Diponegoro University, Semarang, Indonesia
| | - Gijsbert H W Verrips
- Healthy Living, Child Health, Netherlands Organisation for Applied Scientific Research TNO, Leiden, Netherlands
| | - Achmad Zulfa Juniarto
- Faculty of Medicine, Center for Biomedical Research, Diponegoro University, Semarang, Indonesia.,Dr. Kariadi Hospital, Semarang, Indonesia
| | - Sultana M H Faradz
- Faculty of Medicine, Center for Biomedical Research, Diponegoro University, Semarang, Indonesia.,Dr. Kariadi Hospital, Semarang, Indonesia
| | - Stenvert L S Drop
- Department of Pediatrics, Erasmus Medical Center Rotterdam, Sophia Children's Hospital, Rotterdam, Netherlands
| | - Arianne B Dessens
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center Rotterdam, Sophia Children's Hospital, Rotterdam, Netherlands
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16
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Astuti GDN, Arno G, Hull S, Pierrache L, Venselaar H, Carss K, Raymond FL, Collin RWJ, Faradz SMH, van den Born LI, Webster AR, Cremers FPM. Mutations in AGBL5, Encoding α-Tubulin Deglutamylase, Are Associated With Autosomal Recessive Retinitis Pigmentosa. Invest Ophthalmol Vis Sci 2017; 57:6180-6187. [PMID: 27842159 DOI: 10.1167/iovs.16-20148] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose AGBL5, encoding ATP/GTP binding protein-like 5, was previously proposed as an autosomal recessive retinitis pigmentosa (arRP) candidate gene based on the identification of missense variants in two families. In this study, we performed next-generation sequencing to reveal additional RP cases with AGBL5 variants, including protein-truncating variants. Methods Whole-genome sequencing (WGS) or whole-exome sequencing (WES) was performed in three probands. Subsequent Sanger sequencing and segregation analysis were performed in the selected candidate genes. The medical history of individuals carrying AGBL5 variants was reviewed and additional ophthalmic examinations were performed, including fundus photography, fundus autofluorescence imaging, and optical coherence tomography. Results AGBL5 variants were identified in three unrelated arRP families, comprising homozygous variants in family 1 (c.1775G>A:p.(Trp592*)) and family 2 (complex allele: c.[323C>G; 2659T>C]; p.[(Pro108Arg; *887Argext*1)]), and compound heterozygous variants (c.752T>G:p.(Val251Gly) and c.1504dupG:p.(Ala502Glyfs*15)) in family 3. All affected individuals displayed typical RP phenotypes. Conclusions Our study convincingly shows that variants in AGBL5 are associated with arRP. The identification of AGBL5 and TTLL5, a previously described RP-associated gene encoding the tubulin tyrosine ligase-like family, member 5 protein, highlights the importance of poly- and deglutamylation in retinal homeostasis. Further studies are required to investigate the underlying disease mechanism associated with AGBL5 variants.
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Affiliation(s)
- Galuh D N Astuti
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands 2Radboud Institute for Molecular Life Sciences, Radboud University, Nijmegen, The Netherlands 3Division of Human Genetics, Center for Biomedical Research, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Gavin Arno
- University College London, Institute of Ophthalmology, London, United Kingdom
| | - Sarah Hull
- University College London, Institute of Ophthalmology, London, United Kingdom
| | - Laurence Pierrache
- The Rotterdam Eye Hospital, Rotterdam, The Netherlands 6Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands 7Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands 8Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hanka Venselaar
- Centre for Molecular and Biomolecular Informatics, Radboud University, Nijmegen, The Netherlands
| | - Keren Carss
- Department of Haematology, University of Cambridge, Cambridge, United Kingdom 11National Institute for Health Research England BioResource-Rare Diseases, Cambridge University Hospitals, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - F Lucy Raymond
- National Institute for Health Research England BioResource-Rare Diseases, Cambridge University Hospitals, Cambridge Biomedical Campus, Cambridge, United Kingdom 12Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Cambridge, United Kingdom
| | - Rob W J Collin
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands 13Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, The Netherlands
| | - Sultana M H Faradz
- Division of Human Genetics, Center for Biomedical Research, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | | | - Andrew R Webster
- University College London, Institute of Ophthalmology, London, United Kingdom
| | - Frans P M Cremers
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands 13Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, The Netherlands
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17
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Lim GXY, Yeo M, Koh YY, Winarni TI, Rajan-Babu IS, Chong SS, Faradz SMH, Guan M. Validation of a commercially available test that enables the quantification of the numbers of CGG trinucleotide repeat expansion in FMR1 gene. PLoS One 2017; 12:e0173279. [PMID: 28278294 PMCID: PMC5344422 DOI: 10.1371/journal.pone.0173279] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 02/13/2017] [Indexed: 11/26/2022] Open
Abstract
In the present study, we evaluated a commercially available TP-PCR-based assay, the FastFraXTMFMR1 Sizing kit, as a test in quantifying the number of CGG repeats in the FMR1 gene. Based on testing with well characterized DNA samples from Coriell, the kit yielded size results within 3 repeats of those obtained by common consensus (n = 14), with the exception of one allele. Furthermore, based on data obtained using all Coriell samples with or without common consensus (n = 29), the Sizing kit was 97.5% in agreement with existing approaches. Additionally, the kit generated consistent size information in repeatability and reproducibility studies (CV 0.39% to 3.42%). Clinical performance was established with 198 archived clinical samples, yielding results of 100% sensitivity (95% CI, 91.03% to 100%) and 100% specificity (95% CI, 97.64% to 100%) in categorizing patient samples into the respective normal, intermediate, premutation and full mutation genotypes.
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Affiliation(s)
| | - Minli Yeo
- The BioFactory Pte Ltd, Singapore, Singapore
| | | | - Tri Indah Winarni
- Division of Human Genetics, Center for Biomedical Research, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Indhu-Shree Rajan-Babu
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Samuel S. Chong
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat–National University Children’s Medical Institute, National University Health System, Singapore, Singapore
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Sultana M. H. Faradz
- Division of Human Genetics, Center for Biomedical Research, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Ming Guan
- The BioFactory Pte Ltd, Singapore, Singapore
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18
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Ayers KL, Bouty A, Robevska G, van den Bergen JA, Juniarto AZ, Listyasari NA, Sinclair AH, Faradz SMH. Variants in congenital hypogonadotrophic hypogonadism genes identified in an Indonesian cohort of 46,XY under-virilised boys. Hum Genomics 2017; 11:1. [PMID: 28209183 PMCID: PMC5314676 DOI: 10.1186/s40246-017-0098-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 02/11/2017] [Indexed: 11/16/2022] Open
Abstract
Background Congenital hypogonadotrophic hypogonadism (CHH) and Kallmann syndrome (KS) are caused by disruption to the hypothalamic-pituitary-gonadal (H-P-G) axis. In particular, reduced production, secretion or action of gonadotrophin-releasing hormone (GnRH) is often responsible. Various genes, many of which play a role in the development and function of the GnRH neurons, have been implicated in these disorders. Clinically, CHH and KS are heterogeneous; however, in 46,XY patients, they can be characterised by under-virilisation phenotypes such as cryptorchidism and micropenis or delayed puberty. In rare cases, hypospadias may also be present. Results Here, we describe genetic mutational analysis of CHH genes in Indonesian 46,XY disorder of sex development patients with under-virilisation. We present 11 male patients with varying degrees of under-virilisation who have rare variants in known CHH genes. Interestingly, many of these patients had hypospadias. Conclusions We postulate that variants in CHH genes, in particular PROKR2, PROK2, WDR11 and FGFR1 with CHD7, may contribute to under-virilisation phenotypes including hypospadias in Indonesia.
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Affiliation(s)
- Katie L Ayers
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Aurore Bouty
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Gorjana Robevska
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | | | - Achmad Zulfa Juniarto
- Division of Human Genetics, Centre for Biomedical Research, Faculty of Medicine, Diponegoro University (FMDU), JL. Prof. H. Soedarto, SH, Tembalang, Semarang, 50275, Central Java, Indonesia
| | - Nurin Aisyiyah Listyasari
- Division of Human Genetics, Centre for Biomedical Research, Faculty of Medicine, Diponegoro University (FMDU), JL. Prof. H. Soedarto, SH, Tembalang, Semarang, 50275, Central Java, Indonesia
| | - Andrew H Sinclair
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Sultana M H Faradz
- Division of Human Genetics, Centre for Biomedical Research, Faculty of Medicine, Diponegoro University (FMDU), JL. Prof. H. Soedarto, SH, Tembalang, Semarang, 50275, Central Java, Indonesia.
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19
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Ediati A, Juniarto AZ, Birnie E, Okkerse J, Wisniewski A, Drop S, Faradz SMH, Dessens A. Social stigmatisation in late identified patients with disorders of sex development in Indonesia. BMJ Paediatr Open 2017; 1:e000130. [PMID: 29637149 PMCID: PMC5862183 DOI: 10.1136/bmjpo-2017-000130] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/21/2017] [Accepted: 08/22/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess social stigmatisation related to atypical appearance of the body, including, but not limited to the external genitalia, among Indonesian patients with a disorder of sex development (DSD). Until recently, diagnostic evaluation, information about the underlying causes of DSD and treatment options were sparsely available for these patients. METHODS Eighty-one parents of children and adolescents with DSD (aged 6-17 years) and 34 adult patients with DSD (aged 18-41 years) completed the Social Stigmatisation Scale towards DSD, an instrument developed to assesses the frequency of stigmatisation and the level of stress associated with these experiences. Open-ended questions investigated detailed information on stigmatisation as well as parents' and patients' emotional and behavioural reactions to these experiences. Differences in stigmatisation were explored across sex of rearing, gender change history, treatment status and DSD characteristics that could be easily identified by others (e.g., masculinisation of the body in women). RESULTS Social stigmatisation was reported by patients with atypical appearance of their genitalia, atypical appearance of their body aside from their genitals, among those who displayed cross-gender behaviour and those who changed gender. Among participants reared as women and among children and adolescents who changed gender, social stigmatisation was associated with ostracism, depressive symptoms and social isolation. CONCLUSIONS Patients unable to conceal their condition (those with visible physical atypicality and those who changed gender) experienced social stigmatisation. Stigmatisation was stressful and related to isolation and withdrawal from social interaction. Education about DSD, self-empowerment and medical interventions to prevent atypical physical development may remove barriers to acceptance by others for affected individuals.
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Affiliation(s)
- Annastasia Ediati
- Faculty of Psychology, Diponegoro University, Semarang, Indonesia.,Center for Biomedical Research, Faculty of Medicine, Diponegoro University, Semarang, Jawa Tengah, Indonesia
| | - A Zulfa Juniarto
- Center for Biomedical Research, Faculty of Medicine, Diponegoro University, Semarang, Jawa Tengah, Indonesia.,Dr. Kariadi Hospital, Semarang, Indonesia
| | - Erwin Birnie
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jolanda Okkerse
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC Sophia, Rotterdam, The Netherlands
| | - Amy Wisniewski
- Genitourinary Institute, Cook Children's Hospital, Fort Worth, Texas, USA
| | - Stenvert Drop
- Department of Pediatrics, Erasmus MC Sophia, Rotterdam, The Netherlands
| | - Sultana M H Faradz
- Center for Biomedical Research, Faculty of Medicine, Diponegoro University, Semarang, Jawa Tengah, Indonesia
| | - Arianne Dessens
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC Sophia, Rotterdam, The Netherlands
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20
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Juniarto AZ, van der Zwan YG, Santosa A, Ariani MD, Eggers S, Hersmus R, Themmen APN, Bruggenwirth HT, Wolffenbuttel KP, Sinclair A, White SJ, Looijenga LHJ, de Jong FH, Faradz SMH, Drop SLS. Hormonal evaluation in relation to phenotype and genotype in 286 patients with a disorder of sex development from Indonesia. Clin Endocrinol (Oxf) 2016; 85:247-57. [PMID: 26935236 DOI: 10.1111/cen.13051] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 01/22/2016] [Accepted: 02/28/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The objective of this study was to determine the aetiological spectrum of disorders of sex development (DSD) in a large cohort of underprivileged and undiagnosed patients from Indonesia. METHODS A total of 286 patients with atypical external and/or internal genitalia were evaluated using clinical, hormonal, molecular genetic and histological parameters. RESULTS The age (years) at presentation was 0-0·5 in 41 (14·3%), >0·5-12 in 181 (63·3%) and >12 in 64 cases (22·4%). 46,XY DSD was most common (68·2%, n = 195), 46,XX DSD was found in 23·4% (n = 67) and sex chromosomal DSD in 8·4% (n = 24). In 61·2% of 46,XX DSD patients, 17·9% of 46,XY DSD patients and all sex chromosome DSD patients (29·4% in total), a final diagnosis was reached based on genetic or histological gonadal tissue evaluation. 17-hydroxyprogesterone and androstenedione levels were the most distinctive parameters in 46,XX DSD patients. In 46,XY DSD, diagnostic groups were identified based on the external masculinization score: androgen action disorder (AAD), unknown male undermasculinization (UMU), and gonadal dysgenesis (GD). LH, FSH and testosterone levels were most informative especially in the older age group. HCG tests were of no additional value as no patients with androgen synthesis disorders were found. Hormonal profiles of patients with sex chromosome DSD and a Y-chromosome sequence containing karyotype showed high levels of LH and FSH, and low levels of AMH, inhibin B and testosterone compared with the normal male range. Gene mutations were found in all patients with CAH, but in only 24·5% and 1·8% of patients with AAD and UMU. In 32% of 46,XY GD patients, copy number variants of different genes were found. CONCLUSION A stepwise diagnostic approach led to a molecularly or histologically proven final diagnosis in 29·4% of the patients. The most informative parameters were serum levels of 17-hydroxyprogesterone and androstenedione in 46,XX DSD patients, and serum LH, FSH and testosterone levels in 46,XY DSD patients.
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Affiliation(s)
- A Zulfa Juniarto
- Division of Human Genetics, Center for Biomedical Research Faculty of Medicine Diponegoro University (FMDU), Semarang, Indonesia
| | - Yvonne G van der Zwan
- Department of Paediatrics, Division of Endocrinology, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Pathology, Josephine Nefkens Institute, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Ardy Santosa
- Department of Urology, Dr Kariadi Hospital, Semarang, Indonesia
| | - Mahayu Dewi Ariani
- Division of Human Genetics, Center for Biomedical Research Faculty of Medicine Diponegoro University (FMDU), Semarang, Indonesia
| | - Stefanie Eggers
- Murdoch Children's Research Institute, Royal Children's Hospital and Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Remko Hersmus
- Department of Pathology, Josephine Nefkens Institute, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Axel P N Themmen
- Department of Internal Medicine, Section of Endocrinology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Hennie T Bruggenwirth
- Department of Clinical Genetics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Katja P Wolffenbuttel
- Department of Paediatric Urology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Andrew Sinclair
- Murdoch Children's Research Institute, Royal Children's Hospital and Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Stefan J White
- Centre for Genetic Diseases, MIMR-PHI Institute of Medical Research, Monash University, Clayton, Australia
| | - Leendert H J Looijenga
- Department of Pathology, Josephine Nefkens Institute, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Frank H de Jong
- Division of Human Genetics, Center for Biomedical Research Faculty of Medicine Diponegoro University (FMDU), Semarang, Indonesia
| | - Sultana M H Faradz
- Division of Human Genetics, Center for Biomedical Research Faculty of Medicine Diponegoro University (FMDU), Semarang, Indonesia
| | - Stenvert L S Drop
- Department of Paediatrics, Division of Endocrinology, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands
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21
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Pramukarso DT, Faradz SMH, Sari S, Hadisaputro S. Association between methylenetetrahydrofolate reductase (MTHFR) polymorphism and carotid intima medial thickness progression in post ischaemic stroke patient. Ann Transl Med 2016; 3:324. [PMID: 26734634 DOI: 10.3978/j.issn.2305-5839.2015.12.22] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Hyperhomocysteinemia is associated with an increased risk of atherosclerosis. The main cause of elevated levels of homocysteine is 677T allele, the gene encoded by methylenetetrahydrofolate reductase (MTHFR). Carotid atherosclerosis progression, which can be measured by examination of carotid intima-media thickness (C-IMT), is a predictor of recurrent ischemic stroke. The objective of this study was to determine a relationship between MTHFR polymorphism, homocysteine levels, and increased C-IMT in post- ischemic stroke patients. METHODS This was an epidemiological prospective observational cohort study involving 71 patients with post-ischemic stroke subject of the first (onset 1 month) admitted in the Neurology Clinic of Kariadi Hospital during 2012 to 2013. C-IMT was examined using carotid duplex ultrasound at 1(st), 6(th), and 12(th) month after stroke onset. MTHFR gene polymorphism was examined using polymerase chain reaction-restriction fragment length polymorphisms (PCR-RFLP). Homocysteine level was measured using Axis(®) Homocysteine EIA. RESULTS We found 3 categories of MTHFR gene variation, i.e., 677T/T, 677T/C, and 677C/C. The most frequent allele was MTHFR 677C (88.9%), while the MTHFR 677T allele frequency was 11.1%. The majority allele of the subject population was 677C/C, however, there were 3 subjects (4.2%) who had 677T/T allele. The 677T/T allele group had normal homocysteine level and the lowest mean C-IMT among others. CONCLUSIONS This study supports that the MTHFR 677T allele polymorphism is not associated with hyperhomocysteinemia as well as an increase in C-IMT in post ischemic stroke patients.
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Affiliation(s)
- Dodik T Pramukarso
- 1 Department of Neurology, 2 Center for Biomedical Research (CEBIOR), 3 Department of Internal Medicine, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Sultana M H Faradz
- 1 Department of Neurology, 2 Center for Biomedical Research (CEBIOR), 3 Department of Internal Medicine, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Stefani Sari
- 1 Department of Neurology, 2 Center for Biomedical Research (CEBIOR), 3 Department of Internal Medicine, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Soeharyo Hadisaputro
- 1 Department of Neurology, 2 Center for Biomedical Research (CEBIOR), 3 Department of Internal Medicine, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
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22
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Astuti GDN, Bertelsen M, Preising MN, Ajmal M, Lorenz B, Faradz SMH, Qamar R, Collin RWJ, Rosenberg T, Cremers FPM. Comprehensive genotyping reveals RPE65 as the most frequently mutated gene in Leber congenital amaurosis in Denmark. Eur J Hum Genet 2015; 24:1071-9. [PMID: 26626312 DOI: 10.1038/ejhg.2015.241] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 10/09/2015] [Accepted: 10/14/2015] [Indexed: 12/31/2022] Open
Abstract
Leber congenital amaurosis (LCA) represents the most severe form of inherited retinal dystrophies with an onset during the first year of life. Currently, 21 genes are known to be associated with LCA and recurrent mutations have been observed in AIPL1, CEP290, CRB1 and GUCY2D. In addition, sequence analysis of LRAT and RPE65 may be important in view of treatments that are emerging for patients carrying variants in these genes. Screening of the aforementioned variants and genes was performed in 64 Danish LCA probands. Upon the identification of heterozygous variants, Sanger sequencing was performed of the relevant genes to identify the second allele. In combination with prior arrayed primer extension analysis, this led to the identification of two variants in 42 of 86 cases (49%). Remarkably, biallelic RPE65 variants were identified in 16% of the cases, and one novel variant, p.(D110G), was found in seven RPE65 alleles. We also collected all previously published RPE65 variants, identified in 914 alleles of 539 patients with LCA or early-onset retinitis pigmentosa, and deposited them in the RPE65 Leiden Open Variation Database (LOVD). The in silico pathogenicity assessment of the missense and noncanonical splice site variants, as well as an analysis of their frequency in ~60 000 control individuals, rendered 864 of the alleles to affect function or probably affect function. This comprehensive database can now be used to select patients eligible for gene augmentation or retinoid supplementation therapies.
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Affiliation(s)
- Galuh D N Astuti
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Division of Human Genetics, Center for Biomedical Research (CEBIOR), Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Mette Bertelsen
- Kennedy Center Eye Clinic, Glostrup Hospital, Glostrup, Denmark.,Department of Ophthalmology, Glostrup Hospital, Glostrup, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Markus N Preising
- Department of Ophthalmology, Justus-Liebig University Giessen, Giessen, Germany
| | - Muhammad Ajmal
- Department of Biosciences, Faculty of Science, COMSATS Institute of Information Technology, Islamabad, Pakistan
| | - Birgit Lorenz
- Department of Ophthalmology, Justus-Liebig University Giessen, Giessen, Germany
| | - Sultana M H Faradz
- Division of Human Genetics, Center for Biomedical Research (CEBIOR), Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Raheel Qamar
- Department of Biosciences, Faculty of Science, COMSATS Institute of Information Technology, Islamabad, Pakistan.,Al-Nafees Medical College and Hospital, Isra University, Islamabad, Pakistan
| | - Rob W J Collin
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thomas Rosenberg
- Kennedy Center Eye Clinic, Glostrup Hospital, Glostrup, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Frans P M Cremers
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Biosciences, Faculty of Science, COMSATS Institute of Information Technology, Islamabad, Pakistan
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23
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Micha D, Guo DC, Hilhorst-Hofstee Y, van Kooten F, Atmaja D, Overwater E, Cayami FK, Regalado ES, van Uffelen R, Venselaar H, Faradz SMH, Vriend G, Weiss MM, Sistermans EA, Maugeri A, Milewicz DM, Pals G, van Dijk FS. SMAD2 Mutations Are Associated with Arterial Aneurysms and Dissections. Hum Mutat 2015; 36:1145-9. [PMID: 26247899 DOI: 10.1002/humu.22854] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 07/27/2015] [Indexed: 01/29/2023]
Abstract
We report three families with arterial aneurysms and dissections in which variants predicted to be pathogenic were identified in SMAD2. Moreover, one variant occurred de novo in a proband with unaffected parents. SMAD2 is a strong candidate gene for arterial aneurysms and dissections given its role in the TGF-β signaling pathway. Furthermore, although SMAD2 and SMAD3 probably have functionally distinct roles in cell signaling, they are structurally very similar. Our findings indicate that SMAD2 mutations are associated with arterial aneurysms and dissections and are in accordance with the observation that patients with pathogenic variants in genes encoding proteins involved in the TGF-β signaling pathway exhibit arterial aneurysms and dissections as key features.
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Affiliation(s)
- Dimitra Micha
- Department of Clinical Genetics, Center for Connective Tissue Research, VU University Medical Center, Amsterdam, 1007, MB, The Netherlands
| | - Dong-Chuan Guo
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Yvonne Hilhorst-Hofstee
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, 2300, RC, The Netherlands
| | - Fop van Kooten
- Department of Neurology, Erasmus Medical Centre, Rotterdam, 3000, CA, The Netherlands
| | - Dian Atmaja
- Department of Clinical Genetics, Center for Connective Tissue Research, VU University Medical Center, Amsterdam, 1007, MB, The Netherlands.,Center for Biomedical Research, Faculty of Medicine, Diponegoro University, Semarang, Central Java, Indonesia
| | - Eline Overwater
- Department of Clinical Genetics, Center for Connective Tissue Research, VU University Medical Center, Amsterdam, 1007, MB, The Netherlands.,Department of Clinical Genetics, Academic Medical Center, Amsterdam, 1100, DD, The Netherlands
| | - Ferdy K Cayami
- Department of Clinical Genetics, Center for Connective Tissue Research, VU University Medical Center, Amsterdam, 1007, MB, The Netherlands.,Center for Biomedical Research, Faculty of Medicine, Diponegoro University, Semarang, Central Java, Indonesia
| | - Ellen S Regalado
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - René van Uffelen
- Department of Respiratory Medicine, Albert Schweitzer Hospital, Dordrecht, 3318, AT, The Netherlands
| | - Hanka Venselaar
- Center for Molecular and Biomolecular Genetics (CMBI), Nijmegen, 6500, HB, The Netherlands
| | - Sultana M H Faradz
- Center for Biomedical Research, Faculty of Medicine, Diponegoro University, Semarang, Central Java, Indonesia
| | - Gerrit Vriend
- Center for Molecular and Biomolecular Genetics (CMBI), Nijmegen, 6500, HB, The Netherlands
| | - Marjan M Weiss
- Department of Clinical Genetics, Center for Connective Tissue Research, VU University Medical Center, Amsterdam, 1007, MB, The Netherlands
| | - Erik A Sistermans
- Department of Clinical Genetics, Center for Connective Tissue Research, VU University Medical Center, Amsterdam, 1007, MB, The Netherlands
| | - Alessandra Maugeri
- Department of Clinical Genetics, Center for Connective Tissue Research, VU University Medical Center, Amsterdam, 1007, MB, The Netherlands
| | - Dianna M Milewicz
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Gerard Pals
- Department of Clinical Genetics, Center for Connective Tissue Research, VU University Medical Center, Amsterdam, 1007, MB, The Netherlands
| | - Fleur S van Dijk
- Department of Clinical Genetics, Center for Connective Tissue Research, VU University Medical Center, Amsterdam, 1007, MB, The Netherlands
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Ediati A, Juniarto AZ, Birnie E, Drop SLS, Faradz SMH, Dessens AB. Gender Development in Indonesian Children, Adolescents, and Adults with Disorders of Sex Development. Arch Sex Behav 2015; 44:1339-1361. [PMID: 25813609 DOI: 10.1007/s10508-015-0493-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 04/08/2014] [Accepted: 10/04/2014] [Indexed: 06/04/2023]
Abstract
In most Western countries, clinical management of disorders of sex development (DSD), including ambiguous genitalia, begins at diagnosis soon after birth. For many Indonesian patients born with ambiguous genitalia, limited medical treatment is available. Consequently, affected individuals are raised with ambiguous genitalia and atypical secondary sex characteristics. We investigated gender identity and gender role behavior in 118 Indonesian subjects (77 males, 41 females) with different types of DSD in comparison with 118 healthy controls matched for gender, age, and residential setting (rural, suburban, or urban). In Study 1, we report on methodological aspects of the investigation, including scale adaptation, pilot testing, and determining reliability and validity of measures. In Study 2, we report on gender development in 60 children (42 boys, 18 girls), 24 adolescents (15 boys, 9 girls), and 34 adults (19 men, 15 women) with DSD. The majority of participants with DSD never received any medical or surgical treatment prior to this study. We observed a gender change in all age groups, with the greatest incidence in adults. Among patients who changed, most changed from female to male, possessed a 46,XY karyotype, and had experienced significant masculinization during life. Gender identity confusion and cross-gender behavior was more frequently observed in children with DSD raised as girls compared to boys. Puberty and associated masculinization were related to gender problems in individuals with 46,XY DSD raised female. An integrated clinical and psychological follow-up on gender outcome is necessary prior to puberty and adulthood.
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Affiliation(s)
- Annastasia Ediati
- Department of Clinical Psychology, Faculty of Psychology, Diponegoro University, Tembalang, Semarang, 50275, Indonesia,
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25
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Ediati A, Faradz SMH, Juniarto AZ, van der Ende J, Drop SLS, Dessens AB. Emotional and behavioral problems in late-identified Indonesian patients with disorders of sex development. J Psychosom Res 2015; 79:76-84. [PMID: 25563666 DOI: 10.1016/j.jpsychores.2014.12.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 11/27/2014] [Accepted: 12/09/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim of this study is to investigate emotional and behavioral problems among Indonesian patients with disorders of sex development (DSD) who recently came under clinical management. As diagnostic procedures and treatment had been delayed, patients progressively developed ambiguous bodies, difficult to conceal from outsiders. METHOD We compared 118 Indonesian patients with DSD aged 6-41 years (60 children, 24 adolescents, 34 adults) and 118 healthy control subjects matched for age, gender, and residential settings. We used the Child Behavioral Checklist (CBCL), Youth Self-Report (YSR), and Adult Self-Report (ASR) to examine differences between patient and control groups as well as differences within patients groups. RESULTS On the CBCL, parents of young children with DSD reported significantly more emotional and behavioral problems than parents of matched control. Parents of daughters with CAH reported that their daughters withdrew themselves from social interactions. On the ASR, adults with DSD reported significantly more internalizing problems than controls, particularly anxiety and depression. No other differences in emotional functioning were found across different diagnostic groups. CONCLUSIONS Indonesian patients with DSD who were untreated for most of their lives suffered more emotional and behavioral problems than matched controls. Differences and similarities between our findings and observations in patients from Western countries will be discussed.
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Affiliation(s)
- Annastasia Ediati
- Faculty of Psychology Diponegoro, University, Semarang, Indonesia; Center for Biomedical Research (CEBIOR), Faculty of Medicine, Diponegoro University, Semarang, Indonesia.
| | - Sultana M H Faradz
- Center for Biomedical Research (CEBIOR), Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Achmad Zulfa Juniarto
- Center for Biomedical Research (CEBIOR), Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Jan van der Ende
- Department of Child and Adolescence Psychiatry, Erasmus MC-Sophia, Rotterdam, The Netherlands
| | - Stenvert L S Drop
- Department of Pediatrics, Division of Pediatric Endocrinology, Erasmus MC-Sophia, Rotterdam, The Netherlands
| | - Arianne B Dessens
- Department of Child and Adolescence Psychiatry, Erasmus MC-Sophia, Rotterdam, The Netherlands; Department of Pediatrics, Division of Pediatric Endocrinology, Erasmus MC-Sophia, Rotterdam, The Netherlands
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Muzar Z, Lozano R, Schneider A, Adams PE, Faradz SMH, Tassone F, Hagerman RJ. Methadone use in a male with the FMRI premutation and FXTAS. Am J Med Genet A 2015; 167:1354-9. [PMID: 25900641 DOI: 10.1002/ajmg.a.37030] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 02/08/2015] [Indexed: 01/18/2023]
Abstract
The fragile X-associated tremor ataxia syndrome (FXTAS) is caused by the premutation in FMR1 gene. Recent reports of environmental toxins appear to worsen the progression of FXTAS. Here we present a case of male adult with FXTAS and a long history of methadone use. The patient shows a faster progression in both symptoms of disease and MRI changes compared to what is typically seen in FXTAS. There has been no research regarding the role of narcotics in onset, progression, and severity of FXTAS symptoms. However, research has shown that narcotics can have a negative impact on several neurodegenerative diseases, and we hypothesize that in this particular case, methadone may have contributed to a faster progression of FXTAS as well as exacerbating white matter disease through RNA toxicity seen in premutation carriers.
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Affiliation(s)
- Zukhrofi Muzar
- Center for Biomedical Research, Faculty of Medicine Diponegoro University Semarang, Central Java, Indonesia.,Medical Investigation of Neurodevelopmental Disorders MIND Institute, University of California Davis Medical Center, Sacramento, California
| | - Reymundo Lozano
- Medical Investigation of Neurodevelopmental Disorders MIND Institute, University of California Davis Medical Center, Sacramento, California.,Department of Pediatrics, UC Davis Medical Center, Sacramento, California
| | - Andrea Schneider
- Medical Investigation of Neurodevelopmental Disorders MIND Institute, University of California Davis Medical Center, Sacramento, California.,Department of Pediatrics, UC Davis Medical Center, Sacramento, California
| | - Patrick E Adams
- Medical Investigation of Neurodevelopmental Disorders MIND Institute, University of California Davis Medical Center, Sacramento, California.,Department of Pediatrics, UC Davis Medical Center, Sacramento, California
| | - Sultana M H Faradz
- Center for Biomedical Research, Faculty of Medicine Diponegoro University Semarang, Central Java, Indonesia
| | - Flora Tassone
- Medical Investigation of Neurodevelopmental Disorders MIND Institute, University of California Davis Medical Center, Sacramento, California.,Department of Biochemistry and Molecular Medicine, School of Medicine, University of California at Davis, Davis, Califonia
| | - Randi J Hagerman
- Medical Investigation of Neurodevelopmental Disorders MIND Institute, University of California Davis Medical Center, Sacramento, California.,Department of Pediatrics, UC Davis Medical Center, Sacramento, California
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Purnomo HD, Mundhofir FEP, Sudijanto E, Djokomoeljanto R, Faradz SMH. Combination of Aspartate Aminotranferase and Tumor Necrosis Factor-α as Non Invasive Diagnostic Tools for Non Alcoholic Steatohepatitis (NASH). Acta Med Indones 2015; 47:16-23. [PMID: 25948763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM to develop a non-invasive diagnostic test for non-alcoholic steatohepatitis NASH. METHODS this is a cross-sectional study on non-alcoholic fatty liver disease (NAFLD) subjects. Sample was taken by consecutive sampling method. Diagnostic criteria of NAFLD were confirmed by liver biopsy. Clinical variables include metabolic syndrome, aspartate aminotransferase (AST), alanine aminotransferase (ALT), adiponectine, TNF-, insulin, homeostatic model assessment insulin resistance (HOMA-IR) index and liver biopsy. Patients were divided into two groups based on their liver biopsy, group 1: Non-NASH (NAFLD activity score <3) and group 2: NASH (NAFLD activity score of >4). Statistical analyses were performed using Student's t-test, Mann Whitney U, chi-square, the ROC curve, sensitivity and specificity test. RESULTS fifty NAFLD patients were recruited, 30 males and 20 females. Among these patients, 12 (24%) had type 2 diabetes, 36 (72%) had metabolic syndrome, the remaining 2 (4%) did not fulfilled metabolic syndrome. Liver biopsy confirmed 21 (42%) non- NASH and 29 (58%) NASH respectively. Level of AST and ALT, plasma level of adiponectine and TNF- were statistically different between two groups. The AST level (>25 U/L) in combination with TNF- (>3.28 pg/cc) demonstrated a good diagnostic accuracy for NASH (Accuracy 82%, Sensitivity 76%, Specificity 90%, PPV 92%, and NPV 73%). CONCLUSION the combined diagnostic tests of AST and TNF- plasma levels demonstrated a good accuracy for the detection of NASH among NAFLD patients. This combination test can be used as a noninvasive method to diagnose NASH.
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Affiliation(s)
- Hery D Purnomo
- Department of Internal Medicine, Faculty of Medicine Universitas Diponegoro - dr. Kariadi Hospital, Semarang, Indonesia
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Mundhofir FEP, Sistermans EA, Faradz SMH, Hamel BCJ. p.Ser252Trp and p.Pro253Arg mutations in FGFR2 gene causing Apert syndrome: the first clinical and molecular report of Indonesian patients. Singapore Med J 2013; 54:e72-5. [PMID: 23546041 DOI: 10.11622/smedj.2013055] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Apert syndrome (AS) is a rare autosomal dominant disorder characterised by craniosynostosis and limb malformations, and is associated with congenital heart disease and other systemic malformations, including intellectual disability. We report two Indonesian patients with AS, in whom molecular analysis detected p.Ser252Trp (c.755C>G) and p.Pro253Arg (c.758C>G) mutations in the fibroblast growth factor receptor 2 (FGFR2) gene, respectively. Although the syndrome has been frequently described, this is the first clinical report of AS confirmed by molecular analysis in Indonesia. The difference in severity of clinical features in the two patients may be consistent with a genotype-phenotype correlation of the FGFR2mutation. The management of individuals with AS is best achieved within a multidisciplinary setting. However, in most developing countries, early intervention may be delayed due to late diagnosis, a lack of facilities and financial constraints. This report underpins the benefits of early diagnosis for AS management.
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Affiliation(s)
- Farmaditya E P Mundhofir
- Centre for Biomedical Research (CEBIOR), Faculty of Medicine, Diponegoro University, Dr Sutomo 14, Semarang, Indonesia
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Ediati A, Juniarto AZ, Birnie E, Drop SLS, Faradz SMH, Dessens AB. Body image and sexuality in Indonesian adults with a disorder of sex development (DSD). J Sex Res 2013; 52:15-29. [PMID: 24144298 DOI: 10.1080/00224499.2013.816260] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In Indonesia, disorders of sex development (DSDs) are not well recognized and medical care for affected individuals is scarce. Consequently, many patients live with ambiguous genitalia and appearance. We compared reported outcomes on body image, sexual functioning, and sexual orientation of 39 adults with DSDs (aged 18 to 41) and 39 healthy controls matched for gender, age, and residential setting (urban, suburban, rural). Differences in gender and treatment status (treated or untreated) were also explored. On body image, adults with DSDs reported dissatisfaction with sex-related body parts. Compared to the matched controls, women with DSDs reported greater sexual distress, and men with DSDs reported lower erectile and ejaculation frequencies, and more dissatisfaction with sexual life but not with sexual desire and activities. Men with DSDs who had undergone genital surgery reported higher erectile and ejaculation frequencies than untreated men. More women than men in the DSDs group reported a nonexclusive heterosexual orientation. DSDs and infertility had a great impact on sexuality. Fear of ostracism complicated DSD acceptance. Findings were compared to those of Western studies. Based on these results, education about DSDs and their psychosexual consequences may help reduce the sexual distress and problems in adults with DSDs and improve quality of life.
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Affiliation(s)
- Annastasia Ediati
- a Department of Clinical Psychology, Faculty of Psychology , Diponegoro University
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30
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Mundhofir FEP, Nillesen WM, Van Bon BWM, Smeets D, Pfundt R, van de Ven-Schobers G, Ruiterkamp-Versteeg M, Winarni TI, Hamel BCJ, Yntema HG, Faradz SMH. Subtelomeric chromosomal rearrangements in a large cohort of unexplained intellectually disabled individuals in Indonesia: A clinical and molecular study. Indian J Hum Genet 2013; 19:171-8. [PMID: 24019618 PMCID: PMC3758723 DOI: 10.4103/0971-6866.116118] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
CONTEXT Unbalanced subtelomeric chromosomal rearrangements are often associated with intellectual disability (ID) and malformation syndromes. The prevalence of such rearrangements has been reported to be 5-9% in ID populations. AIMS To study the prevalence of subtelomeric rearrangements in the Indonesian ID population. MATERIALS AND METHODS We tested 436 subjects with unexplained ID using multiplex ligation dependent probe amplification (MLPA) using the specific designed sets of probes to detect human subtelomeric chromosomal imbalances (SALSA P070 and P036D). If necessary, abnormal findings were confirmed by other MLPA probe kits, fluorescent in situ hybridization or Single Nucleotide Polymorphism array. RESULTS A subtelomeric aberration was identified in 3.7% of patients (16/436). Details on subtelomeric aberrations and confirmation analyses are discussed. CONCLUSION This is the first study describing the presence of subtelomeric rearrangements in individuals with ID in Indonesia. Furthermore, it shows that also in Indonesia such abnormalities are a prime cause of ID and that in developing countries with limited diagnostic services such as Indonesia, it is important and feasible to uncover the genetic etiology in a significant number of cases with ID.
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Affiliation(s)
- Farmaditya E P Mundhofir
- Division of Human Genetics, Center for Biomedical Research, Faculty of Medicine Diponegoro University, Semarang, Indonesia ; Department of Human Genetics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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31
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Juniarto AZ, Setiawati BA, Ediati A, van der Zwan YG, Looijenga LHJ, de Jong FH, Dessens A, Drop SLS, Faradz SMH. Virilization due to androgen hypersecretion in a patient with ovarian leydig cell tumor: diagnostic and psychosocial implications. Acta Med Indones 2013; 45:130-135. [PMID: 23770793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Virilization due to hyperandrogenism in women causes male signs and symptoms such as swelling of the clitoris, deepening of the voice, facial hair and increase in body hair. Virilization is caused by less than 0.5% of all ovarian tumors. Here we report a case of virilizing Leydig cell tumor of the left ovary in a 36 year old woman. Misinterpretation of symptoms, conflicting medical information and advice from previous doctors had confused the patient. We performed a diagnostic evaluation including clinical, hormonal parameters, imaging, anatomical pathology examinations, and psychological assessment. Blood analysis showed a high testosterone level. The presence of an ovarian tumor was confirmed by laparoscopy. Since the patient refused ovariectomy, a biopsy of the left ovary was performed. Pathology showed a Leydig cell tumor without histological signs of malignancy. In spite of extensive explanation and psychological counseling, cultural barriers prevented appropriate treatment. An ovarian Leydig cell tumor should always be considered for a woman in the reproductive age with symptoms of virilization. The diagnosis is suspected on the basis of an ovarian mass on examination and further investigation and should be proven by biopsy.
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Affiliation(s)
- Achmad Z Juniarto
- Department of Pediatrics, Erasmus University MC-Sophia Children's Hospital. Rotterdam, The Netherlands.
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Winarni TI, Utari A, Mundhofir FEP, Hagerman RJ, Faradz SMH. Fragile X syndrome: clinical, cytogenetic and molecular screening among autism spectrum disorder children in Indonesia. Clin Genet 2013; 84:577-80. [PMID: 23320543 DOI: 10.1111/cge.12095] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 01/07/2013] [Accepted: 01/07/2013] [Indexed: 11/28/2022]
Abstract
Fragile X testing is a priority in the evaluation of autism spectrum disorders (ASD) cases because identification of the FMR1 mutation leads to new treatment options. This study is focused on determining the prevalence of the FMR1 gene mutation among ASD cases in Indonesia. DSM-IV-TR criteria were administered to diagnose ASD; symptom severity was classified using the Childhood Autism Rating Scale. Cytogenetic analysis, polymerase chain reaction, and Southern blot for FMR1 gene analysis were carried out to confirm the diagnosis of fragile X syndrome. The fragile X site and FMR1 full mutation allele were identified in 3 out of 65 (4.6%) and 4 out of 65 (6.15%) children aged 3-17 years (57 boys and 8 girls), respectively. The Fragile X laboratory workup is essential in the evaluation of patients with ASD. Molecular analysis is most accurate, while cytogenetic documentation of the fragile X site can also be useful if molecular testing is not available.
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Affiliation(s)
- T I Winarni
- Division of Human Genetics, Center for Biomedical Research
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33
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Juniarto AZ, Setyawati BA, Miranti IP, Santosa A, Hersmus R, Stoop H, Cools M, Oosterhuis JW, Drop SLS, Faradz SMH, Looijenga LHJ. Gonadal malignancy in 13 consecutive collected patients with disorders of sex development (DSD) from Semarang (Indonesia). J Clin Pathol 2012; 66:198-204. [DOI: 10.1136/jclinpath-2012-201062] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mundhofir FEP, Smeets D, Nillesen W, Winarni TI, Yntema HG, de Leeuw N, Hamel BCJ, Faradz SMH, van Bon BWM. Monosomy 9pter and trisomy 9q34.11qter in two sisters due to a maternal pericentric inversion. Gene 2012; 511:451-4. [PMID: 22995347 DOI: 10.1016/j.gene.2012.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 05/14/2012] [Accepted: 09/05/2012] [Indexed: 10/27/2022]
Abstract
Pericentric inversions of chromosome 9 leading to unbalanced live-born offspring are relatively rare and so far only four cases have been reported. Here we present two sisters with an unbalanced recombinant chromosome 9 which resulted from a large maternal pericentric inversion inv(9)(p24.3q34.1). Further molecular characterisation of the aberrant chromosome 9 by 250k SNP array analysis showed a terminal 460 kb loss of 9p24.3 and a terminal 8.9 Mb gain of 9q34.11. We compared the clinical features of these two patients with the previous reported four cases as well as with patients with similar sized 9pter deletions or 9qter duplications. Based upon this study, we suggest that the recombinant chromosome 9 phenotype is mainly the result of duplication of a 3.4 Mb region of chromosome 9q34.11q34.13.
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Affiliation(s)
- Farmaditya E P Mundhofir
- Department of Human Genetics, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Michels M, van der Ven AJAM, Djamiatun K, Fijnheer R, de Groot PG, Griffioen AW, Sebastian S, Faradz SMH, de Mast Q. Imbalance of angiopoietin-1 and angiopoetin-2 in severe dengue and relationship with thrombocytopenia, endothelial activation, and vascular stability. Am J Trop Med Hyg 2012; 87:943-6. [PMID: 22949515 DOI: 10.4269/ajtmh.2012.12-0020] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The pathogenesis of plasma leakage during dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) is largely unknown. Angiopoietins are key regulators of vascular integrity: Angiopoietin-1 is stored in platelets and maintains vascular integrity, and endothelium-derived angiopoietin-2 promotes vascular leakage. We determined angiopoietin-1 and angiopoietin-2 levels in a cohort of children in Indonesia with DHF/DSS and related them to plasma leakage markers. Patients with DHF/DSS had reduced angiopoietin-1 and increased angiopoietin-2 plasma levels on the day of admission when compared with levels at discharge and in healthy controls. There was an inverse correlation between angiopoietin-1 and markers of plasma leakage and a positive correlation between angiopoietin-2 and markers of plasma leakage. Angiopoietin-1 levels followed the same trend as the soluble platelet activation marker P-selectin and correlated with platelet counts. Dengue-associated thrombocytopenia and endothelial activation are associated with an imbalance in angiopoietin-2: angiopoietin-1 plasma levels. This imbalance may contribute to the transient plasma leakage in DHF/DSS.
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Affiliation(s)
- Meta Michels
- Department of General Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.
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Winarni TI, Chonchaiya W, Sumekar TA, Ashwood P, Morales GM, Tassone F, Nguyen DV, Faradz SMH, Van de Water J, Cook K, Hamlin A, Mu Y, Hagerman PJ, Hagerman RJ. Immune-mediated disorders among women carriers of fragile X premutation alleles. Am J Med Genet A 2012; 158A:2473-81. [PMID: 22903889 DOI: 10.1002/ajmg.a.35569] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Accepted: 06/20/2012] [Indexed: 12/14/2022]
Abstract
The relative risk of immune-mediated disorders (IMDs) among women carriers of premutation alleles is estimated by a survey for IMDs among 344 carrier women (age 19-81 years; mean 46.35 and SD 12.60) and 72 controls (age 18-87 years; mean 52.40 and SD 15.40). One hundred fifty four (44.77%) women carrier had at least one IMD, as did 20 controls (27.78%). Among women carriers, autoimmune thyroid disorder was the most common (24.4%), then fibromyalgia (10.2%), irritable bowel syndrome (IBS; 9.9%), Raynaud's phenomenon (7.6%), rheumatoid arthritis (RA; 3.8%), Sjögren syndrome (2.6%), systemic lupus erythematosus (SLE; 2.03%), multiple sclerosis (1.74%). Of 55 carriers age 40 or older with FXTAS, 72.73% had at least one IMD, compared to 46.54% of those without FXTAS (n = 159), and 31.58% of controls (n = 57). The estimated odds ratio (OR) for IMD is 2.6 (95% CI 1.2-5.6, P = 0.015) for women with FXTAS relative to those without FXTAS; the likelihood of IMD in carriers without or with FXTAS was also significantly higher than for controls (OR 2.1, 95% CI 1.1-4.2, P = 0.034; OR 5.5, 95% CI 2.4-12.5, P < 0.001, respectively). Similarly, the odds of having an IMD among carriers with FXPOI is about 2.4 times higher when compared to carriers without FXPOI (95% CI 1.1-5.0; P = 0.021). The likelihood of IMD in carriers with or without FXPOI is greater (OR 2.4, 95% CI 1.1-5.0; P = 0.021) compared to that of controls.
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Affiliation(s)
- Tri Indah Winarni
- Medical Investigation of Neurodevelopmental Disorders Institute, University of California, Davis, Health System, Sacramento, USA
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Winarni TI, Mundhofir FEP, Ediati A, Belladona M, Nillesen WM, Yntema HG, Hamel BCJ, Faradz SMH, Hagerman RJ. The fragile X-associated tremor ataxia syndrome (FXTAS) in Indonesia. Clin Genet 2012; 83:263-8. [PMID: 22568721 DOI: 10.1111/j.1399-0004.2012.01899.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 05/04/2012] [Indexed: 11/29/2022]
Abstract
Fragile X-associated disorders caused by the premutation of the FMR1 gene, includes the fragile X-associated tremor/ataxia syndrome (FXTAS). FXTAS affects more than 40% of premutation males over the age of 50 and 75% over the age of 80. FMR1 molecular analysis was done using PCR and confirmed by Southern Blot. Three premutation males were diagnosed FXTAS using quantification based on the standard neurological examination. Cognitive impairment was assessed using Raven and WAIS-R test. MRI was done to identify the middle cerebellar peduncle (MCP) sign, white matter disease and/or cerebral atrophy. Three cases of FXTAS are identified, of five individuals older than 50 years in one family tree two met criteria for definite FXTAS and the third with sub-clinical symptoms, although cognitive and radiological criteria are met. These cases are the first identified FXTAS cases in rural Indonesia. In addition with lack of routine medical follow-up, complications of FXTAS, such as hypertension may go unrecognized and untreated, which may further exacerbate the central nervous system (CNS) findings of FXTAS.
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Affiliation(s)
- T I Winarni
- Division of Human Genetic Center for Biomedical Research, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
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Djamiatun K, van der Ven AJAM, de Groot PG, Faradz SMH, Hapsari D, Dolmans WMV, Sebastian S, Fijnheer R, de Mast Q. Severe dengue is associated with consumption of von Willebrand factor and its cleaving enzyme ADAMTS-13. PLoS Negl Trop Dis 2012; 6:e1628. [PMID: 22563509 PMCID: PMC3341341 DOI: 10.1371/journal.pntd.0001628] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 03/08/2012] [Indexed: 12/27/2022] Open
Abstract
Background Thrombocytopenia, bleeding and plasma leakage are cardinal features of severe dengue. Endothelial cell activation with exocytosis of Weibel-Palade bodies (WPBs) may play an etiological role in this condition. Methods and Principal Findings In a cohort of 73 Indonesian children with dengue hemorrhagic fever (DHF), of which 30 with dengue shock syndrome (DSS), we measured plasma levels of the WPB constituents von Willebrand factor antigen (VWF:Ag), VWF propeptide and osteoprotegerin (OPG), together with activity levels of the VWF-cleaving enzyme ADAMTS-13 and the amount of VWF in a platelet binding conformation (VWF activation factor). Compared with healthy controls (n = 17), children with DHF/DSS had significantly higher levels of VWF:Ag, VWF propeptide and OPG and decreased ADAMTS-13 activity. The VWF activation factor was also significantly higher in DHF/DSS and highest in children who died. There were significant differences in the kinetics of the various WPB constituents: VWF propeptide and OPG levels decreased toward discharge, while VWF:Ag levels were lower than expected at enrollment with plasma levels increasing toward discharge. Moreover, VWF propeptide levels correlated better with markers of disease severity (platelet count, liver enzymes, serum albumin and pleural effusion index) than corresponding VWF levels. Together, these findings suggest that there is consumption of VWF in DHF/DSS. In 4 out of 15 selected children with low ADAMTS-13 levels on admission, we found a remarkable reduction in the large and intermediate VWF multimers in the discharge blood samples, consistent with an acquired von Willebrand disease. Conclusion These findings suggest that severe dengue is associated with exocytosis of WPBs with increased circulating levels of VWF:Ag, VWF propeptide and OPG. High circulating levels of VWF in its active conformation, together with low ADAMTS-13 activity levels, are likely to contribute to the thrombocytopenia and complications of dengue. During the convalescence phase, qualitative defects in VWF with loss of larger VWF multimers may develop. Severe dengue infections are characterized by thrombocytopenia, clinical bleeding and plasma leakage. Activation of the endothelium, the inner lining of blood vessels, leads to the secretion of storage granules called Weibel Palade bodies (WPBs). We demonstrated that severe dengue in Indonesian children is associated with a strong increase in plasma levels of the WPB constituents von Willebrand factor (VWF), VWF propeptide and osteoprotegerin (OPG). An increased amount of the hemostatic protein VWF was in a hyperreactive, platelet binding conformation, and this was most pronounced in the children who died. VWF levels at enrollment were lower than expected from concurrent VWF propeptide and OPG levels and VWF levels did not correlate well with markers of disease severity. Together, this suggests that VWF is being consumed during severe dengue. Circulating levels of the VWF-cleaving enzyme ADAMTS-13 were reduced. VWF is a multimeric protein and a subset of children had a decrease in large and intermediate VWF multimers at discharge. In conclusion, severe dengue is associated with exocytosis of WPBs with consumption of VWF and low ADAMTS-13 activity levels. This may contribute to the thrombocytopenia and complications of dengue.
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Affiliation(s)
- Kis Djamiatun
- Department of Parasitology, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Andre J. A. M. van der Ven
- Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Philip G. de Groot
- Laboratory for Thrombosis and Haemostasis, Department of Clinical Chemistry and Haematology, University Medical Centre, Utrecht, The Netherlands
| | - Sultana M. H. Faradz
- Division of Human Genetics, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - D. Hapsari
- Department of Pediatrics, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Wil M. V. Dolmans
- Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Silvie Sebastian
- Laboratory for Thrombosis and Haemostasis, Department of Clinical Chemistry and Haematology, University Medical Centre, Utrecht, The Netherlands
| | - Rob Fijnheer
- Laboratory for Thrombosis and Haemostasis, Department of Clinical Chemistry and Haematology, University Medical Centre, Utrecht, The Netherlands
| | - Quirijn de Mast
- Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- * E-mail:
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Juniarto AZ, van der Zwan YG, Santosa A, Hersmus R, de Jong FH, Olmer R, Bruggenwirth HT, Themmen APN, Wolffenbuttel KP, Looijenga LHJ, Faradz SMH, Drop SLS. Application of the new classification on patients with a disorder of sex development in indonesia. Int J Endocrinol 2012; 2012:237084. [PMID: 22253624 PMCID: PMC3255103 DOI: 10.1155/2012/237084] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 10/07/2011] [Indexed: 12/24/2022] Open
Abstract
Disorder of sex development (DSD) patients in Indonesia most often do not receive a proper diagnostic evaluation and treatment. This study intended to categorize 88 Indonesian patients in accordance with the new consensus DSD algorithm. Diagnostic evaluation including clinical, hormonal, genetic, imaging, surgical, and histological parameters was performed. Fifty-three patients were raised as males, and 34 as females. Of 22 patients with 46, XX DSD, 15 had congenital adrenal hyperplasia, while in one patient, an ovarian Leydig cell tumor was found. In all 58 46, XY DSD patients, 29 were suspected of a disorder of androgen action (12 with an androgen receptor mutation), and in 9, gonadal dysgenesis was found and, in 20, severe hypospadias e.c.i. Implementation of the current consensus statement in a resource-poor environment is very difficult. The aim of the diagnostic workup in developing countries should be to end up with an evidence-based diagnosis. This is essential to improve treatment and thereby to improve the patients' quality of life.
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Affiliation(s)
- A. Zulfa Juniarto
- Department of Human Genetics, Center for Biomedical Research, Faculty of Medicine Diponegoro University (FMDU), Semarang 50321, Indonesia
| | - Yvonne G. van der Zwan
- Division of Pediatric Endocrinology, Department of Pediatrics, Sophia Children's Hospital, Erasmus MC, P.O. Box 2060, 3000 CD Rotterdam, The Netherlands
| | - Ardy Santosa
- Department of Urology, Dr. Kariadi Hospital, Semarang 50321, Indonesia
| | - Remko Hersmus
- Department of Pathology, Josephine Nefkens Institute, Erasmus University Medical Center, 3015 CE Rotterdam, The Netherlands
| | - Frank H. de Jong
- Section of Endocrinology, Department of Internal Medicine, Erasmus University Medical Center, 3015 CE Rotterdam, The Netherlands
| | - Renske Olmer
- Department of Clinical Genetics, Erasmus University Medical Centre, 3015 CE Rotterdam, The Netherlands
| | - Hennie T. Bruggenwirth
- Department of Clinical Genetics, Erasmus University Medical Centre, 3015 CE Rotterdam, The Netherlands
| | - Axel P. N. Themmen
- Section of Endocrinology, Department of Internal Medicine, Erasmus University Medical Center, 3015 CE Rotterdam, The Netherlands
| | - Katja P. Wolffenbuttel
- Department of Paediatric Urology, Erasmus University Medical Centre, 3015 CE Rotterdam, The Netherlands
| | - Leendert H. J. Looijenga
- Department of Pathology, Josephine Nefkens Institute, Erasmus University Medical Center, 3015 CE Rotterdam, The Netherlands
| | - Sultana M. H. Faradz
- Department of Human Genetics, Center for Biomedical Research, Faculty of Medicine Diponegoro University (FMDU), Semarang 50321, Indonesia
| | - Stenvert L. S. Drop
- Division of Pediatric Endocrinology, Department of Pediatrics, Sophia Children's Hospital, Erasmus MC, P.O. Box 2060, 3000 CD Rotterdam, The Netherlands
- *Stenvert L. S. Drop:
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Djamiatun K, Faradz SMH, Setiati TE, Netea MG, van der Ven AJAM, Dolmans WMV. Increase of plasminogen activator inhibitor-1 and decrease of transforming growth factor-b1 in children with dengue haemorrhagic fever in Indonesia. J Trop Pediatr 2011; 57:424-32. [PMID: 21278057 DOI: 10.1093/tropej/fmq122] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Mortality in children with severe dengue haemorrhagic fever (DHF) in Indonesia is high. The origin of the elevated plasminogen activator inhibitor-1 (PAI-1) levels in these children is unclear. We measured PAI-1, transforming growth factor-β1 (TGF-β1), platelet counts, plasma leakage and liver function in 71 children with DHF (3-15 years old) and in 30 healthy children. We found that PAI-1 concentrations in children with DHF were significantly higher on admission than on Day 2. Circulating TGF-β1 concentrations on admission were significantly lower in DHF than in controls, but on Day 2 increased towards levels in controls. TGF-β1 and PAI-1 concentrations were not correlated on either day. PAI-1 was correlated with platelet count and serum albumin on admission, and with degree of pleural effusion. Liver function tests were mildly elevated but not correlated with PAI-1. In conclusion, elevated PAI-1 concentrations in DHF were associated with platelet counts and plasma leakage.
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Affiliation(s)
- Kis Djamiatun
- Faculty of Medicine, Department of Parasitology, Dr Kariadi Hospital and Faculty of Medicine, Diponegoro University, Semarang, Indonesia.
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Juniarto AZ, Goossens K, Setyawati BA, Drop SL, de Jong FH, Faradz SMH. Correlation between androstenedione and 17-hydroxyprogesterone levels in the saliva and plasma of patients with congenital adrenal hyperplasia. Singapore Med J 2011; 52:810-813. [PMID: 22173250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Congenital adrenal hyperplasia (CAH) or adrenogenital syndrome is the most common cause of female ambiguous genitalia. Management of such patients involves medical treatment using glucocorticoids such as hydrocortisone, prednisone or dexamethasone. Monitoring is done by measurement of 17-hydroxyprogesterone (17-OHP) or androstenedione in serum, plasma or saliva. The aim of this study was to develop a system of monitoring steroid treatment in CAH patients using only saliva. METHODS We studied the saliva of 24 CAH patients who received glucocorticoid replacement therapy. The patients were asked to collect saliva upon awakening, and in the afternoon and evening. The levels of 17-OHP and androstenedione in the saliva as well as in serum were then measured by immunoassay. RESULTS There was a significant positive correlation between 17-OHP in serum and in saliva (R equals 0.929, p-value less than 0.01). A significant positive correlation between androstenedione level in saliva and serum was also found (R equals 0.611, p-value less than 0.01). This study also revealed a significant positive correlation between androstenedione and 17-OHP in serum (R equals 0.647, p-value less than 0.01) and saliva (R equals 0.799, p-value less than 0.01). All patients showed increased level of 17-OHP and androstenedione in the sample collected upon awakening. CONCLUSION Determination of salivary androstenedione and 17-OHP in CAH patients could be a useful alternative to the measurement of these hormones in serum.
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Affiliation(s)
- A Z Juniarto
- Department of Human Genetics, Centre for Biomedical Research, Faculty of Medicine, Diponegoro University, Jalan Dr No. 14 Sutomo, Semarang 50232, Indonesia
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Winarni TI, Utari A, Mundhofir FEP, Tong T, Durbin-Johnson B, Faradz SMH, Tassone F. Identification of expanded alleles of the FMR1 gene among high-risk population in Indonesia by using blood spot screening. Genet Test Mol Biomarkers 2011; 16:162-6. [PMID: 21988366 DOI: 10.1089/gtmb.2011.0089] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The prevalence of Fragile X Syndrome (FXS) is 1 in 4000 in males and 1 in 2500 in males and females, respectively, in the general population. Several screening studies aimed at determining the prevalence of FXS have been conducted in individuals with intellectual disabilities (IDs) with a prevalence varying from 1.15% to 6.3% across different ethnic groups. A previous study in Indonesia showed an FXS prevalence of 1.9% among the ID population. A rapid, effective, and inexpensive method for FMR1 screening, using dried blood spots capable of detecting an expanded FMR1 allele in both males and females, was recently reported. We used this approach to screen 176 blood spots, collected from Central Java, Indonesia, for the presence of expanded FMR1 gene alleles. Samples were collected from high-risk populations: 112 individuals with ID, 32 obtained from individuals with diagnosis of autism spectrum disorders, and 32 individuals with a known family history of FXS. Fourteen subjects carrying an FMR1 expanded allele were identified including 7 premutations (55-200 CGG repeats) and 7 full mutations (>200 repeats). Of the seven subjects identified with a full mutation, one subject was from a non-fragile X family, and six from were families with a history of FXS.
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Affiliation(s)
- Tri Indah Winarni
- Division of Human Genetic Center for Biomedical Research, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
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Djamiatun K, Ferwerda B, Netea MG, van der Ven AJAM, Dolmans WMV, Faradz SMH. Toll-like receptor 4 polymorphisms in dengue virus-infected children. Am J Trop Med Hyg 2011; 85:352-4. [PMID: 21813858 DOI: 10.4269/ajtmh.2011.10-0728] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Differential viral recognition by cells bearing Toll-like receptor 4 (TLR4) polymorphisms Asp299Gly and Thr399Ile may influence susceptibility and severity of dengue virus infection. In central Java, Indonesia, we investigated 201 children with dengue hemorrhagic fever (DHF) and 179 healthy controls. Patients and controls were mostly ethnic Javanese. A nearly complete cosegregation of the two mutations was observed. The TLR4 299/399 genotype was found in five patients and four controls. Prevalence of the TLR4 299/399 genotype did not differ significantly between controls and DHF patients or between patients with different severities of DHF. Also, vascular leakage in patients with different TLR4 genotypes did not differ. Thus, the 299/399 TLR4 haplotype has only minor influence on susceptibility and severity of complicated dengue virus infection.
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Affiliation(s)
- Kis Djamiatun
- Department of Parasitology, Diponegoro University, Semarang, Indonesia.
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Widayanti CG, Ediati A, Tamam M, Faradz SMH, Sistermans EA, Plass AMC. Feasibility of preconception screening for thalassaemia in Indonesia: exploring the opinion of Javanese mothers. Ethn Health 2011; 16:483-499. [PMID: 21797731 DOI: 10.1080/13557858.2011.564607] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Thalassaemia has become a major public health issue in Indonesia. It has been estimated that up to 10% of the population carries a gene associated with beta-thalassaemia. Currently, there is no formal recommendation for thalassaemia screening. This study aimed to explore awareness of thalassaemia, and to explore attitudes regarding carrier testing among Javanese mothers. METHODS A quantitative questionnaire, designed using constructs of the Theory of Planned Behaviour, was applied cross-sectionally. RESULTS Out of 191 mothers who were invited, 180 agreed to participate (RR = 94%), of whom 74 had a child affected with thalassaemia. Both attitudes towards receiving information about thalassaemia, and attitudes towards carrier testing were very positive. Awareness of thalassaemia was poor. Mothers, both those with and without an affected child, had barely heard of thalassaemia, nor of carrier testing. However, all mothers, including those with an affected child expressed high levels of interest in carrier testing. Respondents did not perceive that they had any control over carrier testing, and feared stigmatization and being discriminated against if their carrier status was identified. Attitudes towards carrier testing explained 23% of future reproductive intentions, in addition to perceived stigmatization, education level and 'mother's age' (R (2)=0.44; p=0.001). CONCLUSION Responding mothers expressed high levels of interest in receiving information on both thalassaemia and carrier testing. The less educated and the more deprived they were, the keener they were to receive this information. Overall, awareness of thalassaemia was low. Even mothers with affected children seemed unaware of the inheritance pattern and the recurrent risk of having an affected child in a subsequent pregnancy, showing the need for genetic counselling in Indonesia. It is therefore recommended not only to raise awareness about thalassaemia, but to improve the education of healthcare professionals as well.
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Affiliation(s)
- Costrie Ganes Widayanti
- Biomedical Postgraduate Program on Genetic Counseling, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
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Michels M, Djamiatun K, Faradz SMH, Koenders MMJF, de Mast Q, van der Ven AJAM. High plasma mid-regional pro-adrenomedullin levels in children with severe dengue virus infections. J Clin Virol 2010; 50:8-12. [PMID: 20952250 DOI: 10.1016/j.jcv.2010.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 09/13/2010] [Accepted: 09/14/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) is characterized by hemorrhage, plasma leakage and shock. Adrenomedullin and vasopressin are vaso-active hormones that mediate endothelial permeability, vascular tone and water balance and may therefore play a role during DHF/DSS. Adrenomedullin reduces endothelial permeability and has vasodilatory properties, while vasopressin is a potent vasoconstrictor with anti-diuretic effects. OBJECTIVES To determine mid-regional pro-adrenomedullin (MR-proADM) and copeptin, which are reliable and stable markers for adrenomedullin and vasopressin response, respectively, and relate their plasma concentrations to outcome and markers of plasma leakage in Indonesian children with DHF and DSS. STUDY DESIGN In this observational cohort study Indonesian children with DHF/DSS were enrolled. On study days 0 and 2, plasma MR-proADM and copeptin concentrations as well as parameters of plasma leakage were determined. Plasma MR-proADM and copeptin concentrations were compared to values of healthy controls. RESULTS MR-proADM was increased in both DHF (n=43) and DSS (n=28) vs. controls (n=17), with median (IQR) values of 0.47 (0.40-0.68), 0.56 (0.44-1.00) vs. 0.22 (0.19-0.29) nmol/L, respectively. Additionally, MR-proADM correlated with signs of increased vascular leakage such as low albumin and increased pleural effusion. Copeptin concentrations showed no significant changes as compared to controls. CONCLUSIONS MR-proADM concentrations are elevated in children with DHF and DSS and correlate with the severity of plasma leakage, in contrast to copeptin concentrations. We speculate that adrenomedullin has a functional role in limiting endothelial hyperpermeability during DHF/DSS. Finally, MR-proADM may be a candidate biomarker to predict development of DHF/DSS.
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Affiliation(s)
- Meta Michels
- Department of General Internal Medicine, Radboud University Nijmegen Medical Center, The Netherlands.
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Utari A, Chonchaiya W, Rivera SM, Schneider A, Hagerman RJ, Faradz SMH, Ethell IM, Nguyen DV. Side effects of minocycline treatment in patients with fragile X syndrome and exploration of outcome measures. Am J Intellect Dev Disabil 2010; 115:433-43. [PMID: 20687826 PMCID: PMC4031088 DOI: 10.1352/1944-7558-115.5.433] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Minocycline can rescue the dendritic spine and synaptic structural abnormalities in the fragile X knock-out mouse. This is a review and preliminary survey to document side effects and potential outcome measures for minocycline use in the treatment of individuals with fragile X syndrome. We surveyed 50 patients with fragile X syndrome who received minocycline for at least 2 weeks and found that the most common reported side effect is gastrointestinal difficulty, including loss of appetite. The families reported an improvement in language and behavioral areas. Outcome measures in the design of future randomized clinical trials should include both behavioral and language measures. As with any other treatments, we emphasize that randomized clinical trials are needed to determine the efficacy of minocycline in fragile X syndrome.
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Affiliation(s)
- Agustini Utari
- M.I.N.D. Institute, University of California at Davis Medical Center, USA
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Mundhofir FEP, Kooper AJA, Winarni TI, Smits APT, Faradz SMH, Hamel BCJ. A small (sSMC) chromosome 22 due to a maternal translocation between chromosomes 8 and 22: a case report. Genet Couns 2010; 21:99-108. [PMID: 20420036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
We report on a boy with partial trisomies for chromosomes 8 and 22 caused by the presence of a small supernumerary marker chromosome (sSMC), a der(22)t(8;22)(p22;q11.21), inherited from a t(8;22)(p22;q11.21) translocation carrier mother. He has mild mental retardation, unability to speak distinct words and several minor anomalies i.e. high forehead and hairline, telecanthus, upslanting palpebral fissures, depressed nasal bridge, nail hypoplasia, toe position anomaly and 5th finger clinodactyly. He has two maternal uncles and one maternal aunt with mental retardation. G-banding technique showed 47,XY,+mar whilst his mother's karyotype showed a balanced reciprocal translocation between the chromosomes 8 and 22. Fluorescence In Situ Hybridization (FISH) technique with probes for centromere 22 and 8pter were used to detect the origin of marker chromosome and confirmed the marker chromosome in the proband showing to be extra chromosomal material originated from chromosome 8 and 22. Additional genome wide microarray analysis, using the Affymetrix Nspl 250K SNP array platform was performed to further characterize the marker chromosome and resulted in a der(22)t(8;22)(p22;q11.21). Furthermore, cytogenetic analysis of three affected family members showed the same unbalanced translocation, due to 3:1 meiotic segregation. This indicated the viability of this unbalanced pattern and combined with the recurrent miscarriages by the proband's mother, the mechanism of transmitting extrachromosomal material is probably not a random process. Since, there is no similar translocation (8p;22q) reported and the chromosomal translocation largely exists of additional 8p22-8pter we compare the clinical outcomes with reported cases of 8p22-8pter triplication, although there is a part of genetic material derived from chromosome 22 present. This unique familial chromosome translocation case from Indonesia will give insight in the underlying mechanism of this recurrent chromosomal abnormality and clinical features of the patients will be compared to previously published cases.
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Affiliation(s)
- F E P Mundhofir
- Division of Human Genetics, Center for Biomedical Research, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
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Goossens K, Juniarto AZ, Timmerman MA, Faradz SMH, Wolffenbuttel KP, Drop SLS, de Jong FH. Lack of correlation between phenotype and genotype in untreated 21-hydroxylase-deficient Indonesian patients. Clin Endocrinol (Oxf) 2009; 71:628-35. [PMID: 19226270 DOI: 10.1111/j.1365-2265.2009.03550.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mutations in CYP21A2 lead to deficiency of 21-hydroxylase and can have either severe or moderate effects on phenotype, which can be prevented by early treatment. We studied long-term effects of this deficiency on phenotype in patients who had not been treated for prolonged periods and correlated these phenotypes with the mutations found in our patients. OBJECTIVE To assess the correlation between genotype and phenotype in untreated patients with 21-hydroxylase deficiency. DESIGN Subjects with 21-hydroxylase deficiency were selected from a large population of Indonesian patients with disorders of sexual differentiation. CYP21A2 mutations in these patients were correlated with their phenotype in terms of genital development and steroid hormone levels. PATIENTS Fifteen 46,XX patients with ages between 1 and 33 years, of whom 12 had never been treated before. MEASUREMENTS Mutations in CYP21A2, genital phenotype and steroid hormone levels. RESULTS We found in all patients CYP21A2 mutations which affect enzyme activity, with a relatively high allele frequency of R356W (40%), I172N (20%) and IVS2 - 1A > G (13%). Clitoris length was directly correlated with levels of testosterone, but not with age. The phenotype was not always concordant with the genotype: different phenotypes (mild to severe virilization) were found in sibling pairs with the mutations IVS2 - 13A > G or I172N. The high frequency of homozygous mutants for R356W in patients aged from 1 to 11 years old is remarkable, as this mutation has been described only in salt-wasting patients. In our study, this mutation caused a urogenital sinus in three out of seven cases, whereas in the remaining cases the labia were at least partially fused. This mutation caused severe virilization with remarkably high serum levels of renin. We found one novel substitution in intron 2 (IVS2 - 37A > G), containing the branch site, which is likely to affect the CYP21-enzyme. Two additional intron 2 substitutions were discovered, which are supposed to affect the 21-hydroxylase (i.e. IVS2 + 33A > C and IVS2 + 67C > T). CONCLUSION We conclude that a correlation exists between the concentration of androgens and the extent of virilization. However, there was no clear correlation between genotype and phenotype, except for the mutation R356W.
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Affiliation(s)
- Kristel Goossens
- Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands
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Cools M, Stoop H, Kersemaekers AMF, Drop SLS, Wolffenbuttel KP, Bourguignon JP, Slowikowska-Hilczer J, Kula K, Faradz SMH, Oosterhuis JW, Looijenga LHJ. Gonadoblastoma arising in undifferentiated gonadal tissue within dysgenetic gonads. J Clin Endocrinol Metab 2006; 91:2404-13. [PMID: 16608895 DOI: 10.1210/jc.2005-2554] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of the study was to define the histological origin of gonadoblastomas, allowing the identification of high-risk patients. EXPERIMENTAL DESIGN Sixty paraffin-embedded gonadectomy or gonadal biopsy samples of 43 patients with gonadal dysgenesis were selected from our archives. We studied the morphology and immunohistochemical properties of the germ cells in 40 samples without neoplastic transformation and compared these findings with the morphological and immunohistochemical characteristics of 20 samples containing gonadoblastoma/dysgerminoma. RESULTS The overall incidence of germ cell tumors in our patient series was 35%. In dysgenetic gonads without germ cell neoplasia, besides the presence of areas with testicular and/or ovarian differentiation, areas of undifferentiated gonadal tissue were identified in 13 of 40 samples (32.5%). A subpopulation of germ cells within these undifferentiated areas stained positive for octamer binding transcription factor (OCT)3/4, the stem cell factor receptor, placental-like alkaline phosphatase, and testis-specific protein-Y encoded. Gonadoblastoma germ cells display identical staining results. Moreover, in gonads containing gonadoblastoma, adjacent to this lesion, areas of undifferentiated gonadal tissue with identical immunohistochemical characteristics were identified in 10 of 20 samples (50%). No adjacent tissue was available in five cases, whereas in the five remaining cases, it consisted of streak tissue. In three cases, an accumulation of OCT3/4-positive germ cells in the proximity of the malignant lesions was found, suggesting clonal expansion and final organization into gonadoblastoma nests. CONCLUSIONS Based on these observations, we hypothesize that gonadoblastomas originate from surviving OCT3/4-positive germ cells in areas of undifferentiated gonadal tissue within the dysgenetic gonad. Supportive evidence was obtained that carcinoma in situ arises in regions with testicular differentiation.
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Affiliation(s)
- Martine Cools
- Department of Pathology, Erasmus Medical Center, University Medical Center Rotterdam, Josephine Nefkens Institute, Room 430b, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
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Mairuhu ATA, Setiati TE, Koraka P, Hack CE, Leyte A, Faradz SMH, ten Cate H, Brandjes DPM, Osterhaus ADME, Reitsma PH, van Gorp ECM. Increased PAI-1 plasma levels and risk of death from dengue: no association with the 4G/5G promoter polymorphism. Thromb J 2005; 3:17. [PMID: 16274483 PMCID: PMC1308869 DOI: 10.1186/1477-9560-3-17] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2005] [Accepted: 11/07/2005] [Indexed: 12/04/2022] Open
Abstract
Background Dengue virus infected patients have high plasminogen activator inhibitor type I (PAI-1) plasma concentrations. Whether the insertion/deletion (4G/5G) polymorphism in the promotor region of the PAI-1 gene is associated with increased PAI-1 plasma concentrations and with death from dengue is unknown. We, therefore, investigated the relationship between the 4G/5G polymorphism and PAI-1 plasma concentrations in dengue patients and risk of death from dengue. Methods A total of 194 patients admitted to the Dr. Kariadi Hospital in Semarang, Indonesia, with clinical suspected severe dengue virus infection were enrolled. Blood samples were obtained on day of admission, days 1, 2 and 7 after admission and at a 1-month follow-up visit. Plasma concentrations of PAI-1 were measured using a sandwich ELISA kit. The PAI-1 4G/5G polymorphism was typed by allele-specific PCR analysis. Results Concentrations of PAI-1 on admission and peak values of PAI-1 during admission were higher than the values measured in healthy controls. Survival was significantly worse in patients with PAI-1 concentrations in the highest tertile (at admission: OR 4.7 [95% CI 0.9–23.8], peak value during admission: OR 6.3 [95%CI 1.3–30.8]). No association was found between the PAI-1 4G/5G polymorphism, and PAI-1 plasma concentrations, dengue disease severity and mortality from dengue. Conclusion These data suggest that the 4G/5G polymorphism has no significant influence on PAI-1 concentrations in dengue virus infected patients and is not associated with the risk of death from dengue. Other factors contributing to the variability of PAI-1 plasma concentrations in patients with dengue need to be explored.
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Affiliation(s)
- ATA Mairuhu
- Department of Internal Medicine, Slotervaart Hospital, Louwesweg 6, 1066 EC Amsterdam, The Netherlands
| | - TE Setiati
- Department of Paediatrics, Dr. Kariadi Hospital, Semarang, Indonesia
| | - P Koraka
- Institute of Virology, Erasmus Medical Centre, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - CE Hack
- Department of Immunopathology, Sanquin Research, P.O. Box 9190, 1006 AD Amsterdam, The Netherlands
- Laboratory for Experimental and Clinical Immunology, Academic Medical Centre, Meibergdreef 9, 1100 DD Amsterdam, The Netherlands
- Department of Clinical Chemistry, VU Medical Centre, Amsterdam, The Netherlands
| | - A Leyte
- Hematology and Clinical Chemistry Laboratory, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - SMH Faradz
- Molecular and Cytogenetics Unit, Biotechnology Laboratory, Medical Faculty Diponegoro University, Semarang, Indonesia
| | - H ten Cate
- Department of Internal Medicine, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
- Cardiovascular Research Institute, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - DPM Brandjes
- Department of Internal Medicine, Slotervaart Hospital, Louwesweg 6, 1066 EC Amsterdam, The Netherlands
| | - ADME Osterhaus
- Institute of Virology, Erasmus Medical Centre, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - PH Reitsma
- Laboratory for Experimental Medicine, Academic Medical Centre, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands
| | - ECM van Gorp
- Department of Internal Medicine, Slotervaart Hospital, Louwesweg 6, 1066 EC Amsterdam, The Netherlands
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