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Kim AY, Hughes JJ, Pipitone Dempsey A, Sondergaard Schatz K, Wang T, Gunay-Aygun M. Pitfalls in the Diagnosis of Hereditary Fructose Intolerance. Pediatrics 2020; 146:peds.2019-3324. [PMID: 32709737 DOI: 10.1542/peds.2019-3324] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2019] [Indexed: 12/11/2022] Open
Abstract
Establishing the diagnosis of hereditary fructose intolerance (HFI) remains difficult despite the availability of specific molecular genetic testing of the ALDOB gene. This is attributable, at least in part, to the lack of a specific and practical biomarker. We report the incidental diagnosis of HFI as a consequence of nontargeted genetic testing ordered for alternative indications in 5 patients, including 3 children and 2 adults. Two of the children were diagnosed with HFI after extensive evaluations that ultimately involved clinical or research exome sequencing. The third child was diagnosed with HFI during subsequent genetic testing of at-risk family members. Both adults learned to avoid fructose and remained asymptomatic of HFI before diagnosis. One was diagnosed with HFI during preconception, nontargeted expanded carrier screening. For the other, concern for HFI was initially raised by indeterminate direct-to-consumer genetic testing results. None of these patients presented with infantile acute liver failure or other acute decompensation. Our findings suggest that the emphasis of classic teaching on infantile liver failure after first exposure to fructose may be inadvertently increasing the likelihood of missing cases of HFI characterized by other manifestations. HFI is likely underdiagnosed and should be considered for patients with nonspecific findings as well as for individuals with significant aversion to sweets.
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Affiliation(s)
- Alexander Y Kim
- Department of Genetic Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland; and
| | - Joel J Hughes
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Angela Pipitone Dempsey
- Department of Genetic Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland; and
| | - Krista Sondergaard Schatz
- Department of Genetic Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland; and
| | - Tao Wang
- Department of Genetic Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland; and
| | - Meral Gunay-Aygun
- Department of Genetic Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland; and
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2
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Lambe J, Murphy OC, Mu W, Sondergaard Schatz K, Barañano KW, Venkatesan A. Relapsing-remitting clinical course expands the phenotype of Aicardi-Goutières syndrome. Ann Clin Transl Neurol 2020; 7:254-258. [PMID: 31920009 PMCID: PMC7034496 DOI: 10.1002/acn3.50979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/24/2019] [Revised: 12/20/2019] [Accepted: 12/21/2019] [Indexed: 12/11/2022] Open
Abstract
Aicardi-Goutières syndrome (AGS) is a rare and likely underdiagnosed genetic leukoencephalopathy, typically presenting in infancy with encephalopathy and characteristic neuroimaging features, with residual static neurological deficits. We describe a patient who, following an initial presentation at the age of 12 months in keeping with AGS, exhibited a highly atypical relapsing course of neurological symptoms in adulthood with essentially normal neuroimaging. Whole-exome sequencing confirmed a pathogenic RNASEH2B gene variant consistent with AGS. This case highlights the expanding phenotypes associated with AGS and the potential role of whole-exome sequencing in facilitating an increase in the rate of diagnosis.
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Affiliation(s)
- Jeffrey Lambe
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Olwen C Murphy
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Weiyi Mu
- Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Kristin W Barañano
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arun Venkatesan
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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3
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Murdock DR, Jiang Y, Wangler M, Khayat MM, Sabo A, Juusola J, McWalter K, Schatz KS, Gunay-Aygun M, Gibbs RA. Xia-Gibbs syndrome in adulthood: a case report with insight into the natural history of the condition. Cold Spring Harb Mol Case Stud 2019; 5:a003608. [PMID: 30622101 PMCID: PMC6549549 DOI: 10.1101/mcs.a003608] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 10/17/2018] [Accepted: 01/03/2019] [Indexed: 01/08/2023] Open
Abstract
A 55-yr-old male with severe intellectual disability, behavioral problems, kyphoscoliosis, and dysmorphic features was referred for a genetic evaluation. Chromosomal microarray, RASopathy gene panel, mitochondrial sequencing, and fragile X testing were all negative. Subsequent whole-exome sequencing revealed a heterozygous, truncating variant in the AHDC1 gene, consistent with a diagnosis of Xia-Gibbs syndrome (XGS). Review of his clinical history showed many classic dysmorphic and clinical features of XGS, but no major health issues in adulthood other than intellectual disability. This individual is the oldest published XGS case to date, demonstrates the wide phenotypic spectrum of the disorder, and provides information on the condition's natural history. As more adults undergo genomic studies, we will continue to learn about the adult phenotypes of genetic conditions typically diagnosed in the pediatric setting.
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Affiliation(s)
- David R Murdock
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas 77030, USA
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Yunyun Jiang
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas 77030, USA
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Michael Wangler
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030, USA
- Texas Children's Hospital, Houston, Texas 77030, USA
| | - Michael M Khayat
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas 77030, USA
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Aniko Sabo
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas 77030, USA
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030, USA
| | | | | | - Krista Sondergaard Schatz
- Johns Hopkins University School of Medicine, Department of Pediatrics, Institute of Genetic Medicine, Baltimore, Maryland 21287, USA
| | - Meral Gunay-Aygun
- Johns Hopkins University School of Medicine, Department of Pediatrics, Institute of Genetic Medicine, Baltimore, Maryland 21287, USA
| | - Richard A Gibbs
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas 77030, USA
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030, USA
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4
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Stolerman ES, Francisco E, Stallworth JL, Jones JR, Monaghan KG, Keller-Ramey J, Person R, Wentzensen IM, McWalter K, Keren B, Heron B, Nava C, Heron D, Kim K, Burton B, Al-Musafri F, O'Grady L, Sahai I, Escobar LF, Meuwissen M, Reyniers E, Kooy F, Lacassie Y, Gunay-Aygun M, Schatz KS, Hochstenbach R, Zwijnenburg PJG, Waisfisz Q, van Slegtenhorst M, Mancini GMS, Louie RJ. Genetic variants in the KDM6B gene are associated with neurodevelopmental delays and dysmorphic features. Am J Med Genet A 2019; 179:1276-1286. [PMID: 31124279 DOI: 10.1002/ajmg.a.61173] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 01/03/2019] [Revised: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 12/29/2022]
Abstract
Lysine-specific demethylase 6B (KDM6B) demethylates trimethylated lysine-27 on histone H3. The methylation and demethylation of histone proteins affects gene expression during development. Pathogenic alterations in histone lysine methylation and demethylation genes have been associated with multiple neurodevelopmental disorders. We have identified a number of de novo alterations in the KDM6B gene via whole exome sequencing (WES) in a cohort of 12 unrelated patients with developmental delay, intellectual disability, dysmorphic facial features, and other clinical findings. Our findings will allow for further investigation in to the role of the KDM6B gene in human neurodevelopmental disorders.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Boris Keren
- APHP, Hôpital Armand Trousseau, Paris, France
| | | | | | | | - Katherine Kim
- Division of Genetics, Birth Defects and Metabolism, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois.,Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Barbara Burton
- Division of Genetics, Birth Defects and Metabolism, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois.,Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | | | | | - Luis F Escobar
- Medical Genetics and Neurodevelopmental Center, Peyton Manning Children's, Hospital at St. Vincent, Indianapolis, Indiana
| | | | - Edwin Reyniers
- Medical Genetics, University of Antwerp, Antwerp, Belgium
| | - Frank Kooy
- Medical Genetics, University of Antwerp, Antwerp, Belgium
| | - Yves Lacassie
- Children's Hospital New Orleans, New Orleans, Louisiana.,Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Meral Gunay-Aygun
- Institute of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Ron Hochstenbach
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Petra J G Zwijnenburg
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Quinten Waisfisz
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marjon van Slegtenhorst
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Grazia M S Mancini
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Muriello M, Kim AY, Schatz KS, Beck N, Gunay-Aygun M, Hoover-Fong JE. Growth hormone deficiency, aortic dilation, and neurocognitive issues in Feingold syndrome 2. Am J Med Genet A 2019; 179:410-416. [PMID: 30672094 PMCID: PMC7038632 DOI: 10.1002/ajmg.a.61037] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/12/2018] [Accepted: 12/17/2018] [Indexed: 11/07/2022]
Abstract
We report three patients with Feingold 2 syndrome with the novel features of growth hormone deficiency associated with adenohypophyseal compression, aortic dilation, phalangeal joint contractures, memory, and sleep problems in addition to the typical features of microcephaly, brachymesophalangy, toe syndactyly, short stature, and cardiac anomalies. Microdeletions of chromosome 13q that include the MIR17HG gene were found in all three. One of the patients was treated successfully with growth hormone. In addition to expanding the phenotype of Feingold 2 syndrome, we suggest management of patients with Feingold 2 syndrome include echocardiography at the time of diagnosis in all patients and consideration of evaluation for growth hormone deficiency in patients with short stature.
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Affiliation(s)
- Michael Muriello
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Alexander Y. Kim
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Natalie Beck
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland
- Greenberg Center for Skeletal Dysplasia, Johns Hopkins University, Baltimore, Maryland
| | - Meral Gunay-Aygun
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Julie E. Hoover-Fong
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland
- Greenberg Center for Skeletal Dysplasia, Johns Hopkins University, Baltimore, Maryland
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