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Bertini V, Valetto A, Baldinotti F, Azzarà A, Cambi F, Toschi B, Giacomina A, Gatti GL, Gana S, Caligo MA, Bertelloni S. Blepharophimosis, Ptosis, Epicanthus Inversus Syndrome: New Report with a 197-kb Deletion Upstream of FOXL2 and Review of the Literature. Mol Syndromol 2019; 10:147-153. [PMID: 31191203 DOI: 10.1159/000497092] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2018] [Indexed: 11/19/2022] Open
Abstract
Blepharophimosis, ptosis, and epicanthus inversus syndrome (BPES) is due to heterozygous FOXL2 intragenic mutations in about 70% of the patients, whereas total or partial gene deletions account for a minority of cases. Alteration of FOXL2 regulatory elements has been rarely described in patients with BPES. In this study, a prepubertal girl with BPES due to a 197-kb de novo deletion of the regulatory elements upstream of FOXL2 is reported. This girl presented with additional clinical features such as a soft cleft palate and microcephaly; thus, this copy number variant might have other somatic effects. The present deletion encompasses 2 coding genes (MRPS22 and COPB2), whose homozygous mutations have been associated with microcephaly. In our case, the sequences of the non-deleted allele were normal, ruling out a compound genetic defect. Normal levels of new biomarkers of ovarian reserve (anti-müllerian hormone, inhibin B) likely indicate an early diagnosis of type 2 BPES, but an evolutive gonadal damage will be excluded only by long-term follow-up. Additional reports of microdeletions upstream of FOXL2 are needed to better define the underlying genetic mechanism and the related phenotypic spectrum; the ability of the new hormonal markers to predict ovarian function in adolescence and adulthood should be confirmed.
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Affiliation(s)
- Veronica Bertini
- SOD Citogenetica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Angelo Valetto
- SOD Citogenetica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Fulvia Baldinotti
- SOD Genetica Molecolare, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Alessia Azzarà
- SOD Citogenetica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Francesca Cambi
- SOD Citogenetica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Benedetta Toschi
- Sezione Genetica Medica, Medicina Interna 1, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - Gian L Gatti
- U.O. Chirurgia Plastica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Simone Gana
- Sezione Genetica Medica, Medicina Interna 1, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Maria A Caligo
- SOD Genetica Molecolare, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Silvano Bertelloni
- Pediatric Division, Department of Obstetrics, Gynecology and Pediatrics, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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