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He X, Guo ZW, Niu XM. Case Report: CTC1 mutations in a patient with diffuse hepatic and splenic hemangiomatosis complicated by Kasabach-Merritt syndrome. Front Oncol 2023; 13:1087790. [PMID: 36761951 PMCID: PMC9905704 DOI: 10.3389/fonc.2023.1087790] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/10/2023] [Indexed: 01/26/2023] Open
Abstract
Diffuse hemangiomatosis of the liver and spleen is rare. Currently, few studies are available on diffuse hepatic and splenic hemangiomatosis accompanied by Kasabach-Merritt syndrome (KMS). The conserved telomere maintenance component 1 (CTC1) gene contributes to telomere maintenance and replication by forming the telomeric capping complex. Herein, we report a case of diffuse hemangiomatosis in the liver and spleen accompanied by KMS in a 59-year-old woman who carried two novel heterozygous CTC1 variants: c.435+9A>C and c.3074C>T (p.Ala1025Val). Using next-generation sequencing, we detected mutations in the CTC1 gene in our patient, who had chief complaints of fatigue and abdominal distension complicated by severe thrombocytopenia and consumptive coagulopathy. Clinical symptoms, laboratory tests, and imaging findings led to the diagnosis of diffuse hepatic and splenic hemangiomatosis accompanied by KMS. The patient was treated with prednisone, thalidomide, and sirolimus, and her general condition was ameliorated at the 4-month follow-up with improved platelet count and coagulation function. A CTC1 gene mutation may be involved in the pathological process of vascular diseases. A combination treatment regimen of prednisone, thalidomide, and sirolimus may be effective for KMS.
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Doubková M, Vrzalová Z, Štefániková M, Červinek L, Kozubík KS, Blaháková I, Pospíšilová Š, Doubek M. Germline variant of CTC1 gene in a patient with pulmonary fibrosis and myelodysplastic syndrome. Multidiscip Respir Med 2023; 18:909. [PMID: 37404458 PMCID: PMC10316942 DOI: 10.4081/mrm.2023.909] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/02/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction Telomeropathies are associated with a wide range of diseases and less common combinations of various pulmonary and extrapulmonary disorders. Case presentation In proband with high-risk myelodysplastic syndrome and interstitial pulmonary fibrosis, whole exome sequencing revealed a germline heterozygous variant of CTC1 gene (c.1360delG). This "frameshift" variant results in a premature stop codon and is classified as likely pathogenic/pathogenic. So far, this gene variant has been described in a heterozygous state in adult patients with hematological diseases such as idiopathic aplastic anemia or paroxysmal nocturnal hemoglobinuria, but also in interstitial pulmonary fibrosis. Described CTC1 gene variant affects telomere length and leads to telomeropathies. Conclusions In our case report, we describe a rare case of coincidence of pulmonary fibrosis and hematological malignancy caused by a germline gene mutation in CTC1. Lung diseases and hematologic malignancies associated with short telomeres do not respond well to standard treatment.
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Affiliation(s)
- Martina Doubková
- Department of Pulmonary Diseases and Tuberculosis, University Hospital and Faculty of Medicine, Brno
| | - Zuzana Vrzalová
- Central European Institute of Technology, Masaryk University, Brno
- Department of Internal Medicine - Hematology and Oncology, University Hospital and Faculty of Medicine, Brno
| | - Marianna Štefániková
- Department of Pulmonary Diseases and Tuberculosis, University Hospital and Faculty of Medicine, Brno
| | - Libor Červinek
- Department of Internal Medicine - Hematology and Oncology, University Hospital and Faculty of Medicine, Brno
| | - Kateřina Staňo Kozubík
- Central European Institute of Technology, Masaryk University, Brno
- Department of Internal Medicine - Hematology and Oncology, University Hospital and Faculty of Medicine, Brno
| | - Ivona Blaháková
- Central European Institute of Technology, Masaryk University, Brno
- Department of Internal Medicine - Hematology and Oncology, University Hospital and Faculty of Medicine, Brno
| | - Šárka Pospíšilová
- Central European Institute of Technology, Masaryk University, Brno
- Department of Internal Medicine - Hematology and Oncology, University Hospital and Faculty of Medicine, Brno
- Department of Medical Genetics and Genomics, University Hospital and Faculty of Medicine, Brno, Czech Republic
| | - Michael Doubek
- Central European Institute of Technology, Masaryk University, Brno
- Department of Internal Medicine - Hematology and Oncology, University Hospital and Faculty of Medicine, Brno
- Department of Medical Genetics and Genomics, University Hospital and Faculty of Medicine, Brno, Czech Republic
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Riquelme J, Takada S, van Dijk T, Peña F, Boogaard MW, van Duyvenvoorde HA, Pico-Knijnenburg I, Wit JM, van der Burg M, Mericq V, Losekoot M. Primary Ovarian Failure in Addition to Classical Clinical Features of Coats Plus Syndrome in a Female Carrying 2 Truncating Variants of CTC1. Horm Res Paediatr 2022; 94:448-455. [PMID: 34706368 DOI: 10.1159/000520410] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 06/07/2021] [Accepted: 10/22/2021] [Indexed: 11/19/2022] Open
Abstract
Coats plus syndrome is an autosomal recessive multisystemic and pleiotropic disorder affecting the eyes, brain, bone, and gastrointestinal tract, usually caused by compound heterozygous variants of the conserved telomere maintenance component 1 gene (CTC1), involved in telomere homeostasis and replication. So far, most reported patients are compound heterozygous for a truncating mutation and a missense variant. The phenotype is believed to result from telomere dysfunction, with accumulation of DNA damage, cellular senescence, and stem cell depletion. Here, we report a 23-year-old female with prenatal and postnatal growth retardation, microcephaly, osteopenia, recurrent fractures, intracranial calcification, leukodystrophy, parenchymal brain cysts, bicuspid aortic valve, and primary ovarian failure. She carries a previously reported maternally inherited pathogenic variant in exon 5 (c.724_727del, p.(Lys242Leufs*41)) and a novel, paternally inherited splice site variant (c.1617+5G>T; p.(Lys480Asnfs*17)) in intron 9. CTC1 transcript analysis showed that the latter resulted in skipping of exon 9. A trace of transcripts was normally spliced resulting in the presence of a low level of wild-type CTC1 transcripts. We speculate that ovarian failure is caused by telomere shortening or chromosome cohesion failure in oocytes and granulosa cells, with early decrease in follicular reserve. This is the first patient carrying 2 truncating CTC1 variants and the first presenting primary ovarian failure.
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Affiliation(s)
- Joel Riquelme
- Department of Pediatrics, University of Chile, Hospital San Juan de Dios, Santiago, Chile.,Department of Pediatrics, Clínica Las Condes, Santiago, Chile
| | - Sanami Takada
- Department of Pediatrics, Laboratory for Pediatric Immunology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tessa van Dijk
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Fernanda Peña
- Department of Pediatrics, Hospital San Juan de Dios, Santiago, Chile
| | - Merel W Boogaard
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Ingrid Pico-Knijnenburg
- Department of Pediatrics, Laboratory for Pediatric Immunology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan M Wit
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Mirjam van der Burg
- Department of Pediatrics, Laboratory for Pediatric Immunology, Leiden University Medical Center, Leiden, The Netherlands
| | - Veronica Mericq
- Department of Pediatrics, Clínica Las Condes, Santiago, Chile.,Institute of Maternal and Child Research, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Monique Losekoot
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
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Abstract
BACKGROUND Coats plus syndrome is a rare multisystem disorder, and is also a telomere-related disorder caused by CTC1 gene mutation. We reported ophthalmic findings in a Chinese child with genetically confirmed Coats plus syndrome. MATERIALS AND METHODS The comprehensive ophthalmic findings were presented, as well as treatment history and systemic manifestations. In addition, genetic testing was performed to confirm the diagnosis. RESULTS Examination under anesthesia showed notable retinal vasculopathy, including vascular tortuosity and dilation, abnormal vascular anastomosis, retinal telangiectasias and mild exudation, extensive peripheral avascularity, as well as the presence of retinal neovascularization. The patient developed vitreous hemorrhage and tractional retinal detachment, and then underwent vitrectomy. Meanwhile, the patient was noted to have growth retardation and leukoencephalopathy. Gene testing identified a compound heterozygous mutation in CTC1 gene: a novel splicing site mutation (c.33 + 1 G > T) and a deletion mutation (c.2954_2956del, p.C985del), which were inherited from his mother and father, respectively. CONCLUSIONS The present report expanded the genotype and phenotype spectrum of CTC1 gene associated with Coats plus syndrome.
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Affiliation(s)
- Tingyi Liang
- Department of Ophthalmology, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Xiang Zhang
- Department of Ophthalmology, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Yu Xu
- Department of Ophthalmology, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Peiquan Zhao
- Department of Ophthalmology, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai, China
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