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Forero LT, Henderson R, Galarreta C, Swee S, Bird LM. Expansion of the core features of VACTERL association to include genital anomalies. Am J Med Genet A 2024:e63587. [PMID: 38687163 DOI: 10.1002/ajmg.a.63587] [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] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/01/2024] [Accepted: 02/26/2024] [Indexed: 05/02/2024]
Abstract
Genital anomalies have been reported with VACTERL association but not considered a core feature. Acute and chronic complications stemming from unrecognized genital anomalies have been reported in adolescents and young adults with VACTERL association. We sought to determine the frequency and severity of genital anomalies in VACTERL patients and identify which core features were more frequently associated with genital anomalies. A retrospective chart review from January 2010 to October 2021 identified 211 patients with two or more core VACTERL features, 34% of whom had a genital anomaly. The majority of genital anomalies (83% of those in males and 90% in females) were classified as functionally significant (requiring surgical intervention or causing functional impairment). The frequency of genital anomalies in the VACTERL cohort was higher if anorectal malformations or renal anomalies were present in both males and females and if vertebral anomalies were present in females. Due to their functional significance, genital anomalies should be assessed in all patients with two or more core features of VACTERL association, especially in those with anorectal or renal anomalies. Most genital anomalies in males will be detected on physical examination but additional investigation is often needed to detect genital anomalies in females. The timing and type of investigation are subjects for future study.
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Affiliation(s)
- Laura T Forero
- Department of Pediatrics, Division of Genetics and Dysmorphology, UC San Diego/Rady Children's Hospital, San Diego, California, USA
| | | | - Carolina Galarreta
- Department of Genetics and Metabolism, Valley Children's Hospital, Madera, California, USA
| | - Steven Swee
- Division of Extended Studies, University of California, San Diego, California, USA
| | - Lynne M Bird
- Department of Pediatrics, Division of Genetics and Dysmorphology, UC San Diego/Rady Children's Hospital, San Diego, California, USA
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Gomes A, Zapata LF, Galarreta CI, Henderson R, Hoyt E, Swee S, Bird LM. Substantial incidence of bladder dysfunction in patients with VACTERL association: Implications for surveillance. Am J Med Genet A 2024; 194:320-327. [PMID: 37822287 DOI: 10.1002/ajmg.a.63443] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023]
Abstract
VACTERL association is defined as the nonrandom co-occurrence of a minimum of three of the following six key components: Vertebral anomalies, Anal atresia, Cardiac malformations, Tracheo-Esophageal fistula, Renal anomalies, and Limb abnormalities. Patients presenting with two components may also belong in the same spectrum. Additional components have been associated with VACTERL defects, including single umbilical artery, tethered spinal cord (TSC), and genital malformations. We observed a significant proportion of patients with bladder dysfunction (often called neurogenic bladder in the medical record) when reviewing a cohort of patients with VACTERL defects at our clinical center. Our finding calls attention to bladder dysfunction as an additional VACTERL phenotypic component. The prevalence of bladder dysfunction is greatest in those with genital anomalies, anorectal malformations, sacral dysplasia, renal anomalies, and TSC. We propose that patients with two or more VACTERL malformations be monitored for symptoms of bladder dysfunction if one or more of the identified risk factors are present until the achievement of urinary continence.
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Affiliation(s)
- Adriana Gomes
- Division of Dysmorphology/Genetics, Department of Pediatrics and Rady Children's Hospital San Diego, University of California, San Diego, La Jolla, California, USA
| | - Laura Forero Zapata
- Division of Dysmorphology/Genetics, Department of Pediatrics and Rady Children's Hospital San Diego, University of California, San Diego, La Jolla, California, USA
| | - Carolina I Galarreta
- Medical Genetics and Metabolism Department, Valley Children's Hospital, Madera, California, USA
| | - Riley Henderson
- Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Erin Hoyt
- Pediatric Resident PGY-3 Valley Children's Healthcare, Madera, California, USA
| | - Steven Swee
- Division of Extended Studies, University of California, San Diego, La Jolla, California, USA
| | - Lynne M Bird
- Division of Dysmorphology/Genetics, Department of Pediatrics and Rady Children's Hospital San Diego, University of California, San Diego, La Jolla, California, USA
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Passanisi S, D'Angelo G, Marseglia L, De Cola C, Granese R, Conti G, Betta P, Cutrupi MC, Fede C, Chimenz R, Salpietro C, Gitto E. Renal anomalies in newborns with vacterel association: case series and literature review. J BIOL REG HOMEOS AG 2019; 33:53-58. Special Issue: Focus on Pediatric Nephrology. [PMID: 31630714] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Nocturnal enuresis (NE) was defined by the World Health Organization (ICD-10) and the American Psychiatric Association (DSM-5) as bed-wetting in children aged >5 years. In cases of mental retardation, the developmental age may be equivalent to 5 years. In this review, we focus on the current knowledge about the etiology of enuresis and the most recent therapeutical options. Both non-pharmacological and pharmacological therapies are included, although the relative effectiveness of each remains uncertain. To date, motivational, alarm and drug therapies are the mainstay of treatment. Alarm therapy remains the first-line treatment modality for NE, while desmopressin is the most commonly used medical treatment.
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Affiliation(s)
- S Passanisi
- Neonatal Intensive Care Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Italy
| | - G D'Angelo
- Neonatal Intensive Care Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Italy
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - L Marseglia
- Neonatal Intensive Care Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Italy
| | - C De Cola
- Neonatal Intensive Care Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Italy
| | - R Granese
- Obstetrics and Gynecology Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Italy
| | - G Conti
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", Unit of Pediatric Nephrology and Rheumatology with Dialysis, University of Messina, Policlinico "G. Martino" Messina, Italy
| | - P Betta
- Neonatal Intensive Care Unit, Policlinico-Vittorio Emanuele" of Catania, Italy
| | - M C Cutrupi
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", Unit of Emergency Pediatrics, University of Messina, Policlinico "G. Martino" Messina, Italy
| | - C Fede
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", Unit of Pediatric Nephrology and Rheumatology with Dialysis, University of Messina, Policlinico "G. Martino" Messina, Italy
| | - R Chimenz
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", Unit of Pediatric Nephrology and Rheumatology with Dialysis, University of Messina, Policlinico "G. Martino" Messina, Italy
| | - C Salpietro
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", Unit of Emergency Pediatrics, University of Messina, Policlinico "G. Martino" Messina, Italy
| | - E Gitto
- Neonatal Intensive Care Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Italy
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Diaz J, Chavers B, Chinnakotla S, Verghese P. Outcomes of kidney transplants in pediatric patients with the vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula, renal anomalies, limb abnormalities association. Pediatr Transplant 2019; 23:e13341. [PMID: 30597716 DOI: 10.1111/petr.13341] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/17/2018] [Accepted: 06/10/2018] [Indexed: 11/29/2022]
Abstract
In this single-center retrospective study, we analyzed kidney transplant outcomes in nine pediatric patients with VACTERL [vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula, renal anomalies, limb abnormalities] association-making this the largest study of its kind. Of 743 pediatric kidney transplant recipients at our center (1980-2017), nine had documented diagnoses of VACTERL association. All nine had congenital anorectal malformations and renal anomalies, five had vertebral defects, and one had a bifid thumb and tracheoesophageal fistula. Renal anomalies included dysplasia (n = 6), aplasia (n = 3), and horseshoe kidney (n = 2). Congenital lower urinary tract anomalies included neurogenic bladder (n = 6), obstructive uropathy (n = 4), anovesicular fistula (n = 1), rectourethral fistula (n = 1), and posterior urethral valves (n = 1). Age at transplant ranged from 1.2 to 15 years (mean, 7.3; standard deviation [SD], 5.5); 6 (67%) were male, and 3 (33%) were female; 6 (67%) had a living related donor, and 3 (33%) had a deceased donor. The overall graft survival rate was 78% (range, 1.5 to 25.2 years; mean, 10.5; SD, 8.9). One month post-transplant, one recipient died with a functioning graft. At 3.7 years post-transplant, one graft failed because of recurrent pyelonephritis. Post-transplant urologic complications included pyelonephritis (n = 6), vesicoureteral reflux (n = 5), and graft hydronephrosis (n = 4). We conclude that pediatric patients with VACTERL association can be safely transplanted-careful patient selection with vigilance and intervention for pre- and post-transplant urologic complications is essential.
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Affiliation(s)
- Jessica Diaz
- University of Minnesota Medical School, Minneapolis, Minnesota.,Fairview Perioperative Services, Minneapolis, Minnesota
| | - Blanche Chavers
- Division of Nephrology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Srinath Chinnakotla
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Priya Verghese
- Division of Nephrology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
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Husain M, Dutra-Clarke M, Lemieux B, Wencel M, Solomon BD, Kimonis V. Phenotypic diversity of patients diagnosed with VACTERL association. Am J Med Genet A 2018; 176:1830-1837. [PMID: 30152190 DOI: 10.1002/ajmg.a.40363] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 12/18/2017] [Revised: 05/19/2018] [Accepted: 05/21/2018] [Indexed: 12/21/2022]
Abstract
The combination of vertebral, anal, cardiac, tracheo-esophageal, renal and limb anomalies termed VACTERL association, also referred to as VATER, has been used as a clinical descriptor and more recently, a diagnosis of exclusion, for a specific group of phenotypic manifestations that have been observed to co-occur non-randomly. Though the causes remain elusive and poorly understood in most patients, VACTERL association is thought to be due to defects in early embryogenesis and is likely genetically heterogeneous. We present data on 36 patients diagnosed with VACTERL association in addition to describing the phenotypic diversity of each component feature. Unique cases in our cohort include a patient with a 498.59 kb microdeletion in the 16p11.2 region and another with a 215 kb duplication in the 3p25.2 region. Our findings expand upon the current understanding of VACTERL association and guide future research aimed at determining its etiology.
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Affiliation(s)
- Majid Husain
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California-Irvine, School of Medicine, Irvine, California, USA
| | - Marina Dutra-Clarke
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California-Irvine, School of Medicine, Irvine, California, USA
| | - Bryan Lemieux
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California-Irvine, School of Medicine, Irvine, California, USA
| | - Marie Wencel
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California-Irvine, School of Medicine, Irvine, California, USA
| | | | - Virginia Kimonis
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California-Irvine, School of Medicine, Irvine, California, USA
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Reutter H, Hilger AC, Hildebrandt F, Ludwig M. Underlying genetic factors of the VATER/VACTERL association with special emphasis on the "Renal" phenotype. Pediatr Nephrol 2016; 31:2025-33. [PMID: 26857713 PMCID: PMC5207487 DOI: 10.1007/s00467-016-3335-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 11/23/2015] [Revised: 01/14/2016] [Accepted: 01/15/2016] [Indexed: 12/18/2022]
Abstract
The acronym VATER/VACTERL association (OMIM #192350) refers to the rare non-random co-occurrence of the following component features (CFs): vertebral defects (V), anorectal malformations (A), cardiac defects (C), tracheoesophageal fistula with or without esophageal atresia (TE), renal malformations (R), and limb defects (L). According to epidemiological studies, the majority of patients with VATER/VACTERL association present with a "Renal" phenotype comprising a large spectrum of congenital renal anomalies. This finding is supported by evidence linking all of the human disease genes for the VATER/VACTERL association identified to date, namely, FGF8, FOXF1, HOXD13, LPP, TRAP1, and ZIC3, with renal malformations. Here we review these genotype-phenotype correlations and suggest that the elucidation of the genetic causes of the VATER/VACTERL association will ultimately provide insights into the genetic causes of the complete spectrum of congenital renal anomalies per se.
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Affiliation(s)
- Heiko Reutter
- Institute of Human Genetics, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany. .,Department of Neonatology and Pediatric Intensive Care, Children's Hospital-University of Bonn, Bonn, Germany.
| | - Alina C Hilger
- Institute of Human Genetics, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Friedhelm Hildebrandt
- Department of Medicine, Boston Children's Hospital-Harvard Medical School, Boston, MA, USA
| | - Michael Ludwig
- Department of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany
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Abstract
VACTERL-H association includes three of eight features: vertebral anomalies, anal atresia, congenital heart disease, tracheo-esophageal fistula, esophageal atresia, renal, limb anomalies, and hydrocephalus. The VACTERL-H phenotype among cases with FA is considered to be about 5%; the frequency of FA among patients with VACTERL-H is unknown. We examined 54 patients with FA in the National Cancer Institute Inherited Bone Marrow Failure Syndrome Cohort for features of VACTERL-H, including imaging studies (radiology and ultrasound). Eighteen of the fifty-four patients had three or more VACTERL-H features. The presence of VACTERL-H association in 33% of those with FA is much higher than the previous estimate of 5% (P < 0.0001). We created the acronym PHENOS (Pigmentation, small Head, small Eyes, central Nervous system (not hydrocephalus), Otology, and Short stature) which includes all major phenotypic features of FA that are not in VACTERL-H; these findings were more frequent in the patients with FA who had VACTERL-H. Identification of any components of the VACTERL-H association should lead to imaging studies, and to consideration of the diagnosis of FA, particularly if the patient has radial ray and renal anomalies, as well as many features of PHENOS. There was no association of the presence or absence of VACTERL-H with development of cancer, stem cell transplant, or survival. Early diagnosis will lead to genetic counseling and early surveillance and management of complications of FA. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Blanche P Alter
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Neelam Giri
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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8
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Cunningham BK, Khromykh A, Martinez AF, Carney T, Hadley DW, Solomon BD. Analysis of renal anomalies in VACTERL association. ACTA ACUST UNITED AC 2014; 100:801-5. [PMID: 25196458 DOI: 10.1002/bdra.23302] [Citation(s) in RCA: 28] [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] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/01/2014] [Accepted: 08/04/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND VACTERL association refers to a combination of congenital anomalies that can include: vertebral anomalies, anal atresia, cardiac malformations, tracheo-esophageal fistula with esophageal atresia, renal anomalies (typically structural renal anomalies), and limb anomalies. METHODS We conducted a description of a case series to characterize renal findings in a cohort of patients with VACTERL association. Out of the overall cohort, 48 patients (with at least three component features of VACTERL and who had abdominal ultrasound performed) met criteria for analysis. Four other patients were additionally analyzed separately, with the hypothesis that subtle renal system anomalies may occur in patients who would not otherwise meet criteria for VACTERL association. RESULTS Thirty-three (69%) of the 48 patients had a clinical manifestation affecting the renal system. The most common renal manifestation (RM) was vesicoureteral reflux (VUR) in addition to a structural defect (present in 27%), followed by unilateral renal agenesis (24%), and then dysplastic/multicystic kidneys or duplicated collected system (18% for each). Twenty-two (88%) of the 25 patients with a structural RM had an associated anorectal malformation. Individuals with either isolated lower anatomic anomalies, or both upper and lower anatomic anomalies were not statistically more likely to have a structural renal defect than those with isolated upper anatomic anomalies (p = 0.22, p = 0.284, respectively). CONCLUSION Given the high prevalence of isolated VUR in our cohort, we recommend a screening VCUG or other imaging modality be obtained to evaluate for VUR if initial renal ultrasound shows evidence of obstruction or renal scarring, as well as ongoing evaluation of renal health.
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Affiliation(s)
- Bridget K Cunningham
- Department of Pediatrics, Walter Reed National Military Medical Center-Bethesda, Maryland; Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
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Cunningham BK, Hadley DW, Hannoush H, Meltzer AC, Niforatos N, Pineda-Alvarez D, Sachdev V, Warren-Mora N, Solomon BD. Analysis of cardiac anomalies in VACTERL association. ACTA ACUST UNITED AC 2014; 97:792-7. [PMID: 24343877 DOI: 10.1002/bdra.23211] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [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: 09/16/2013] [Revised: 10/22/2013] [Accepted: 10/31/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND Congenital heart disease (CHD) is estimated to affect between 3 and 5% of all newborns. Extra-cardiac malformations are observed in 7 to 50% of patients with CHD. One relatively well-known association that can occur in the context of CHD is VACTERL. Controversy still remains regarding the definition of VATER association and its expansion to VACTERL, the appropriate diagnostic criteria and the overall incidence. METHODS We conducted a description of a case series to characterize the cardiac findings present in a cohort of patients meeting the criteria for VACTERL association. RESULTS Forty-six of 220 were eligible for inclusion into the study, 67% (31 of 46) had CHD. The most common CHD was ventricular septal defect, present in 18 of 31 patients (58%). There was no statistically significant association between CHD severity and the presence or absence of other VACTERL component features, specifically anorectal malformation (p = 0.18) or tracheo-esophageal fistula (p = 0.72). CHD presence also did not correlate with the presence of tracheo-esophageal fistula or anorectal malformation. CONCLUSION Although this study does not, by design, provide further evidence toward the questions of whether CHD is a defining feature of VACTERL association, the frequency of CHD in our cohort does lend support to it being an important medical consideration in patients with VACTERL association. Based on our experience, we strongly recommend a screening echocardiogram to evaluate for CHD in individuals with a potential diagnosis of VACTERL association.
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Affiliation(s)
- Bridget K Cunningham
- Department of Pediatrics, Walter Reed National Military Medical Center-Bethesda, Maryland; Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
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Abstract
Patients with Fanconi anemia (FA) often have birth defects that suggest the diagnosis of VATER association. A review of 2,245 cases of FA reported in the literature from 1927 to 2012 identified 108 cases with at least 3 of the defining features of VATER association; only 29 had been so noted by the authors. The FA VATER signature was the significantly higher frequency of renal and limb (radial and/or thumb) anomalies (93% of cases had both) compared with less than 30% of VATER patients; the presence of one or both of these birth defects should lead to testing for FA. The relative frequencies of the genotypes of the patients with FA VATER were strikingly different from those expected from the general FA population; only 19% were FANCA, while 21% were FANCB, 14% FANCD1/BRCA2, and 12% FANCD2. Consistent with their genotypes, those with the FA VATER phenotype had a worse prognosis than FA patients with milder phenotypes, with shorter median survival and earlier onset of malignancies. The early identification of FA patients among infants with VATER association should lead to earlier more proactive management, such as cancer surveillance and genetic counseling.
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Affiliation(s)
- B P Alter
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Md., USA
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Brosens E, Eussen H, van Bever Y, van der Helm RM, Ijsselstijn H, Zaveri HP, Wijnen R, Scott DA, Tibboel D, de Klein A. VACTERL Association Etiology: The Impact of de novo and Rare Copy Number Variations. Mol Syndromol 2013; 4:20-6. [PMID: 23653573 DOI: 10.1159/000345577] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Copy number variations (CNVs), either DNA gains or losses, have been found at common regions throughout the human genome. Most CNVs neither have a pathogenic significance nor result in disease-related phenotypes but, instead, reflect the normal population variance. However, larger CNVs, which often arise de novo, are frequently associated with human disease. A genetic contribution has long been suspected in VACTERL (Vertebral, Anal, Cardiac, TracheoEsophageal fistula, Renal and Limb anomalies) association. The anomalies observed in this association overlap with several monogenetic conditions associated with mutations in specific genes, e.g. Townes Brocks (SALL1), Feingold syndrome (MYCN) or Fanconi anemia. So far VACTERL association has typically been considered a diagnosis of exclusion. Identifying recurrent or de novo genomic variations in individuals with VACTERL association could make it easier to distinguish VACTERL association from other syndromes and could provide insight into disease mechanisms. Sporadically, de novo CNVs associated with VACTERL are described in literature. In addition to this literature review of genomic variation in published VACTERL association patients, we describe CNVs present in 68 VACTERL association patients collected in our institution. De novo variations (>30 kb) are absent in our VACTERL association cohort. However, we identified recurrent rare CNVs which, although inherited, could point to mechanisms or biological processes contributing to this constellation of developmental defects.
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Affiliation(s)
- E Brosens
- Department of Clinical Genetics, Erasmus Medical Centre, The Netherlands ; Department of Pediatric Surgery, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
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12
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Abstract
VACTERL/VATER association is a group of congenital malformations characterized by at least 3 of the following findings: vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities. To date, no unifying etiology for VACTERL/VATER association has been established, and there is strong evidence for causal heterogeneity. VACTERL/VATER association has many overlapping characteristics with other congenital disorders that involve multiple malformations. In addition to these other conditions, some of which have known molecular causes, certain aspects of VACTERL/VATER association have similarities with the manifestations of disorders caused by mitochondrial dysfunction. Mitochondrial dysfunction can result from a number of distinct causes and can clinically manifest in diverse presentations; accurate diagnosis can be challenging. Case reports of individuals with VACTERL association and confirmed mitochondrial dysfunction allude to the possibility of mitochondrial involvement in the pathogenesis of VACTERL/VATER association. Further, there is biological plausibility involving mitochondrial dysfunction as a possible etiology related to a diverse group of congenital malformations, including those seen in at least a subset of individuals with VACTERL association.
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Affiliation(s)
| | - B.D. Solomon
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Md., USA
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