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1.
Brain ; 146(12): 4880-4890, 2023 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-37769650

RESUMO

Congenital insensitivity to pain (CIP) and hereditary sensory and autonomic neuropathies (HSAN) are clinically and genetically heterogeneous disorders exclusively or predominantly affecting the sensory and autonomic neurons. Due to the rarity of the diseases and findings based mainly on single case reports or small case series, knowledge about these disorders is limited. Here, we describe the molecular workup of a large international cohort of CIP/HSAN patients including patients from normally under-represented countries. We identify 80 previously unreported pathogenic or likely pathogenic variants in a total of 73 families in the >20 known CIP/HSAN-associated genes. The data expand the spectrum of disease-relevant alterations in CIP/HSAN, including novel variants in previously rarely recognized entities such as ATL3-, FLVCR1- and NGF-associated neuropathies and previously under-recognized mutation types such as larger deletions. In silico predictions, heterologous expression studies, segregation analyses and metabolic tests helped to overcome limitations of current variant classification schemes that often fail to categorize a variant as disease-related or benign. The study sheds light on the genetic causes and disease-relevant changes within individual genes in CIP/HSAN. This is becoming increasingly important with emerging clinical trials investigating subtype or gene-specific treatment strategies.


Assuntos
Neuropatias Hereditárias Sensoriais e Autônomas , Insensibilidade Congênita à Dor , Humanos , Insensibilidade Congênita à Dor/genética , Neuropatias Hereditárias Sensoriais e Autônomas/genética , Mutação/genética
2.
Am J Hum Genet ; 108(7): 1231-1238, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34089648

RESUMO

Genetic disorders are a leading contributor to mortality in neonatal and pediatric intensive care units (ICUs). Rapid whole-genome sequencing (rWGS)-based rapid precision medicine (RPM) is an intervention that has demonstrated improved clinical outcomes and reduced costs of care. However, the feasibility of broad clinical deployment has not been established. The objective of this study was to implement RPM based on rWGS and evaluate the clinical and economic impact of this implementation as a first line diagnostic test in the California Medicaid (Medi-Cal) program. Project Baby Bear was a payor funded, prospective, real-world quality improvement project in the regional ICUs of five tertiary care children's hospitals. Participation was limited to acutely ill Medi-Cal beneficiaries who were admitted November 2018 to May 2020, were <1 year old and within one week of hospitalization, or had just developed an abnormal response to therapy. The whole cohort received RPM. There were two prespecified primary outcomes-changes in medical care reported by physicians and changes in the cost of care. The majority of infants were from underserved populations. Of 184 infants enrolled, 74 (40%) received a diagnosis by rWGS that explained their admission in a median time of 3 days. In 58 (32%) affected individuals, rWGS led to changes in medical care. Testing and precision medicine cost $1.7 million and led to $2.2-2.9 million cost savings. rWGS-based RPM had clinical utility and reduced net health care expenditures for infants in regional ICUs. rWGS should be considered early in ICU admission when the underlying etiology is unclear.


Assuntos
Estado Terminal/terapia , Medicina de Precisão , Sequenciamento Completo do Genoma , California , Estudos de Coortes , Efeitos Psicossociais da Doença , Cuidados Críticos , Feminino , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Masculino , Medicaid , Estudos Prospectivos , Resultado do Tratamento , Estados Unidos
3.
Am J Med Genet A ; 176(1): 167-170, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29150902

RESUMO

Wieacker-Wolff syndrome is a rare congenital syndrome with few reported cases in the current literature. It is traditionally described in males as an X-linked recessive disorder associated with congenital contractures of the feet, progressive neurologic muscular atrophy, and intellectual delay caused by ZC4H2 mutations. The purpose of this paper is to present a female individual with a classic phenotype and cleft palate, a previously undescribed finding in this syndrome. Recent reports have demonstrated that females are rarely severely affected and phenotypic expression is difficult to predict [Zanzottera et al. (); American Journal of Medical Genetics Part A 173A: 1358-1363]. This case supports the unpredictability of Wieacker-Wolff syndrome severity and prompts future questions regarding female mutations and phenotypic expression.


Assuntos
Apraxias/diagnóstico , Apraxias/genética , Fissura Palatina/diagnóstico , Fissura Palatina/genética , Contratura/diagnóstico , Contratura/genética , Estudos de Associação Genética , Doenças Genéticas Ligadas ao Cromossomo X/diagnóstico , Doenças Genéticas Ligadas ao Cromossomo X/genética , Atrofia Muscular/diagnóstico , Atrofia Muscular/genética , Oftalmoplegia/diagnóstico , Oftalmoplegia/genética , Proteínas de Transporte/genética , Pré-Escolar , Cromossomos Humanos X , Fácies , Feminino , Testes Genéticos , Humanos , Peptídeos e Proteínas de Sinalização Intracelular , Mutação , Proteínas Nucleares , Linhagem , Fenótipo
4.
Clin Case Rep ; 5(7): 1152-1154, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28680615

RESUMO

We report a case of Noonan syndrome with loose anagen hair (NS/LAH), a rare variant of Noonan syndrome, with associated trichorrhexis nodosa and trichoptilosis. The SHOC2 mutation may be responsible for these additional hair shaft defects, revealing the importance of microscopic examination of hairs in these patients.

5.
Pediatr Dermatol ; 34(3): e132-e134, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28318055

RESUMO

Althouygh Menkes disease has well-recognized neurologic, developmental, and cutaneous features, the initial presentation may resemble child abuse. We describe a 5-month-old boy with multiple fractures indicative of nonaccidental trauma who was ultimately diagnosed with Menkes disease. Copper deficiency leads to connective tissue abnormalities and may result in subdural hematomas, wormian bones, cervical spine defects, rib fractures, and spurring of the long bone metaphyses. Several of these findings, including fractures and subdural hematomas, may be misinterpreted as child abuse.


Assuntos
Maus-Tratos Infantis/diagnóstico , Fraturas Múltiplas/diagnóstico por imagem , Recém-Nascido Prematuro , Síndrome dos Cabelos Torcidos/diagnóstico , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Seguimentos , Fraturas Múltiplas/diagnóstico , Humanos , Lactente , Masculino , Síndrome dos Cabelos Torcidos/diagnóstico por imagem , Radiografia/métodos , Medição de Risco
6.
J Pediatr ; 159(4): 623-7.e1, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21489556

RESUMO

OBJECTIVE: To determine whether subjects of Puerto Rican heritage are at increased risk for a specific mutation of the proton-coupled folate transporter (PCFT) causing hereditary folate malabsorption (HFM). STUDY DESIGN: Three percent of the births in Puerto Rico in 2005, with additional regional oversampling, were screened for the prevalence of the c.1082G>A; p.Y362_G389 del PCFT gene mutation. Six new subjects of Puerto Rican heritage with the clinical diagnosis of HFM were also assessed for this mutation. RESULTS: Six subjects of Puerto Rican heritage with the clinical diagnosis of HFM were all homozygous for the c.1082G>A; p.Y362_G389 del PCFT mutation. Three heterozygote carriers were identified from the 1582 newborn samples randomly selected from births in Puerto Rico in 2005. The carrier frequency for the mutated allele was 0.2% island-wide and 6.3% in Villalba. CONCLUSION: These findings are consistent with a common mutation in the PCFT gene causing HFM that has disseminated to Puerto Ricans who have migrated to mainland United States. Because prompt diagnosis and treatment of infants with HFM can prevent the consequences of this disorder, newborn screening should be considered in high-risk populations and physicians should be aware of its prevalence in infants of Puerto Rican ancestry.


Assuntos
Ácido Fólico/metabolismo , Hispânico ou Latino/genética , Síndromes de Malabsorção/genética , Mutação , Transportador de Folato Acoplado a Próton/genética , Triagem de Portadores Genéticos , Testes Genéticos , Homozigoto , Humanos , Recém-Nascido , Porto Rico
7.
Clin Immunol ; 133(3): 287-94, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19740703

RESUMO

Hereditary folate malabsorption is a rare inborn error of metabolism due to mutations in the proton-coupled folate transporter (PCFT). Clinical presentation of PCFT deficiency may mimic severe combined immune deficiency (SCID). We report a 4-month-old female who presented with failure to thrive, normocytic anemia, Pneumocystis jirovecii pneumonia and systemic cytomegalovirus infection. Immunological evaluation revealed hypogammaglobulinemia, absent antibody responses, and lack of mitogen-induced lymphocyte proliferative responses. However, the absolute number and distribution of lymphocyte subsets, including naïve T cells and recent thymic emigrants, were normal, arguing against primary SCID. Serum and cerebrospinal fluid folate levels were undetectable. A homozygous 1082-1G>A mutation of the PCFT gene was found, resulting in skipping of exon 3. Parenteral folinic acid repletion resulted in normalization of anemia, humoral and cellular immunity, and full clinical recovery. PCFT mutations should be considered in infants with SCID-like phenotype, as the immunodeficiency is reversible with parenteral folinic acid repletion.


Assuntos
Ácido Fólico/imunologia , Proteínas de Membrana Transportadoras/imunologia , Mutação Puntual , Imunodeficiência Combinada Severa/imunologia , Sequência de Bases , DNA/química , DNA/genética , Feminino , Citometria de Fluxo , Ácido Fólico/sangue , Ácido Fólico/metabolismo , Variação Genética , Humanos , Imunofenotipagem , Lactente , Absorção Intestinal , Leucovorina/administração & dosagem , Masculino , Proteínas de Membrana Transportadoras/genética , Reação em Cadeia da Polimerase , Transportador de Folato Acoplado a Próton , Imunodeficiência Combinada Severa/genética , Imunodeficiência Combinada Severa/metabolismo , Linfócitos T/imunologia
8.
Clin Dysmorphol ; 16(1): 35-38, 2007 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17159512

RESUMO

Oculo-ectodermal syndrome is a rare condition characterized by aplasia cutis and epibulbar dermoids. We present the case of a 6-year-old girl with oculo-ectodermal syndrome, who was found to have an arachnoid cyst by head computed tomography. This is the third case of oculo-ectodermal syndrome with arachnoid cyst reported in the literature, and suggests that arachnoid cyst may be a phenotypic feature of oculo-ectodermal syndrome.


Assuntos
Cistos Aracnóideos/patologia , Displasia Ectodérmica/patologia , Anormalidades do Olho/patologia , Adulto , Cistos Aracnóideos/genética , Povo Asiático , Criança , Displasia Ectodérmica/genética , Anormalidades do Olho/genética , Feminino , Humanos , Masculino , Síndrome , Tomografia Computadorizada por Raios X
9.
Am J Med Genet A ; 140(24): 2730-41, 2006 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-17103451

RESUMO

Mowat-Wilson syndrome (MWS) is a relatively newly described multiple congenital anomaly/mental retardation syndrome. Haploinsufficiency of a gene termed ZFHX1B (also known as SIP1) on chromosome 2 is responsible for this condition, and clinical genetic testing for MWS recently became available. The majority of reports in the literature originate from Northern Europe and Australia. Here we report our clinical experience with 12 patients diagnosed with MWS within a 2-year period of time in the United States, with particular emphasis on clinical characteristics and management strategies. Individuals with this condition have characteristic facial features, including microcephaly, hypertelorism, medially flared and broad eyebrows, prominent columella, pointed chin, and uplifted earlobes, which typically prompt the clinician to consider the diagnosis. Medical issues in our cohort of patients included seizures (75%) with no predeliction for any particular seizure type; agenesis of the corpus callosum (60% of our patients studied); congenital heart defects (75%), particularly involving the pulmonary arteries and/or valves; hypospadias (55% of males); severely impaired or absent speech (100% of individuals over 1 year of age) with relatively spared receptive language; and Hirschsprung disease (50%) or chronic constipation (25%). The incidence of MWS is unknown, but based on the number of patients identified in a short period of time within the US, it is likely greatly under recognized. MWS should be considered in any individual with severely impaired or absent speech, especially in the presence of seizures and anomalies involving the pulmonary arteries (particularly pulmonary artery sling) or pulmonary valves.


Assuntos
Anormalidades Múltiplas/genética , Deficiência Intelectual/genética , Anormalidades Múltiplas/diagnóstico , Anormalidades Múltiplas/terapia , Adolescente , Adulto , Agenesia do Corpo Caloso , Criança , Pré-Escolar , Anormalidades Craniofaciais/genética , Feminino , Doença de Hirschsprung/genética , Proteínas de Homeodomínio/genética , Humanos , Lactente , Recém-Nascido , Transtornos do Desenvolvimento da Linguagem/genética , Masculino , Artéria Pulmonar/anormalidades , Proteínas Repressoras/genética , Convulsões/genética , Síndrome , Homeobox 2 de Ligação a E-box com Dedos de Zinco
10.
J Invest Dermatol ; 126(11): 2408-13, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16902423

RESUMO

Harlequin ichthyosis (HI) is the most severe form of autosomal-recessive, congenital ichthyosis. Affected infants have markedly impaired barrier function and are more susceptible to infection. Abnormalities in the localization of epidermal lipids as well as abnormal lamellar granule formation are features of HI skin. Previously, we and others have shown that mutations in the ABCA12 gene encoding an adenosine triphosphate-binding cassette (ABC) transporter underlie the skin disease HI. In this study, we have sequenced the ABCA12 gene in an additional 14 patients and show that all contain mutations, with the majority being either nonsense substitution or frameshift mutations. Eleven HI patients had bi-allelic ABCA12 mutations, whereas in the remaining three HI patients in this study, ABCA12 mutations were detected on only one allele by sequencing. In addition, the one patient from the previous study where no sequence mutations were detected was screened for heterozygous deletions. A combination of oligonucleotide arrays, multiplex PCR analysis and single-nucleotide polymorphism genotyping revealed a heterozygous intragenic deletion in exon 8. These mutation data establish ABCA12 as the major HI gene.


Assuntos
Transportadores de Cassetes de Ligação de ATP/genética , Ictiose Lamelar/genética , Códon sem Sentido , Análise Mutacional de DNA , Éxons/genética , Feminino , Mutação da Fase de Leitura , Humanos , Masculino , Mutação , Análise de Sequência com Séries de Oligonucleotídeos , Reação em Cadeia da Polimerase , Polimorfismo de Nucleotídeo Único , Deleção de Sequência
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