Using a combination of MLPA kits to detect chromosomal imbalances in patients with multiple congenital anomalies and mental retardation is a valuable choice for developing countries

Conventional karyotyping detects anomalies in 3-15% of patients with multiple congenital anomalies and mental retardation (MCA/MR). Whole-genome array screening (WGAS) has been consistently suggested as the first choice diagnostic test for this group of patients, but it is very costly for large-scale use in developing countries. We evaluated the use of a combination of Multiplex Ligation-dependent Probe Amplification (MLPA) kits to increase the detection rate of chromosomal abnormalities in MCA/MR patients. We screened 261 MCA/MR patients with two subtelomeric and one microdeletion kits. This would theoretically detect up to 70% of all submicroscopic abnormalities. Additionally we scored the de Vries score for 209 patients in an effort to find a suitable cut-off for MLPA screening. Our results reveal that chromosomal abnormalities were present in 87 (33.3%) patients, but only 57 (21.8%) were considered causative. Karyotyping detected 15 abnormalities (6.9%), while MLPA identified 54 (20.7%). Our combined MLPA screening raised the total detection number of pathogenic imbalances more than three times when compared to conventional karyotyping. We also show that using the de Vries score as a cutoff for this screening would only be suitable under financial restrictions. A decision analytic model was constructed with three possible strategies: karyotype, karyotype + MLPA and karyotype + WGAS. Karyotype + MLPA strategy detected anomalies in 19.8% of cases which account for 76.45% of the expected yield for karyotype + WGAS. Incremental Cost Effectiveness Ratio (ICER) of MLPA is three times lower than that of WGAS, which means that, for the same costs, we have three additional diagnoses with MLPA but only one with WGAS. We list all causative alterations found, including rare findings, such as reciprocal duplications of regions deleted in Sotos and Williams-Beuren syndromes. We also describe imbalances that were considered polymorphisms or rare variants, such as the new SNP that confounded the analysis of the 22q13.3 deletion syndrome. (C) 2011 Elsevier Masson SAS. All rights reserved.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)CEPID (Centro de Pesquisa, Inovacao e Difusao)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Univ São Paulo, Inst Biociencias, Dept Genet & Biol Evolut, Ctr Estudos Genoma Humano, BR-05508900 São Paulo, BrazilUniv São Paulo, Fac Med, Dept Oncol, BR-05508 São Paulo, BrazilUniv Fed Campina Grande, Campina Grande, PB, BrazilUniversidade Federal de São Paulo, Dept Ginecol, Lab Ginecol Mol, São Paulo, BrazilAssoc Beneficente Coleta Sangue, São Paulo, BrazilUniv São Paulo, Fac Med, Inst Crianca, BR-05508 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Ginecol, Lab Ginecol Mol, São Paulo, BrazilWeb of Scienc

Molecular aspects of craniosynostoses: implications in diagnosis and genetic counseling

Graniossinostose caracteriza-se pelo fechamento prematuro de uma ou mais suturas cranianas. As craniossinostoses formam um grupo bastante heterogêneo, com uma incidência de 1 para 2000-3000 nascimentos. Tanto fatores ambientais como genéticos podem estar relacionados com o surgimento das craniossinostoses. Na última década, verificou-se que mutações em 4 genes (FGFR1, FGFR2, FGFR3, TWIST) podem causar formas sindrômicas de craniossinostose bem definidas clinicamente, a saber: Sindromes de Apert, Pfeiffer, Crouzon, Jackson-Weiss, Beare-Stevenson e Saethre-Chotzen. Ainda, duas novas síndromes foram clinicamente e molecularmente caracterizadas: a síndrome de Muenke e a de Boston. O quadro clínico associado com estas duas formas de craniossinostose é bastante variado. incluindo desde paciente com crânio em trevo até aqueles com apenas craniossinostose da sutura coronal (bilateral ou unilateral), os quais são classificados como portadores de craniossinostose não sindrômica. Uma precisa correlação fenótipo-genótipo têm sido difícil na grande maioria dos casos devido à sobreposição do quadro clínico e pela heterogeneidade genética do grupo, e portanto o teste molecular pode ser importante para o diagnóstico de um grande número de pacientes. O padrão de herança das craniossinostoses acima referidas é o autossômico dominante, o que significa que um indivíduo afetado possui 50% de chance de vir a ter um filho afetado com a mesma condição. Outros padrões de herança também têm sido relatados, sendo sempre importante uma avaliação genética e clínica de todos os membros da família do afetado. Exemplificamos com dois casos atendidos em nosso laboratório, a importância do uso de testes moleculares para a confirmação do diagnóstico e realização precisa do aconselhamento genético.Craniosynostosis is characterized by the premature closure of one or more cranial sutures. It is a highly heterogeneous group, with an incidence of 1 per 2000-3000 births. Both environmental and genetic factors play a role in its etiology. In the last decade, it has been shown that mutations i0 4 genes (FGFR1, FGFR2, FGFR3, TWIST) may cause very well known craniosynostotic syndromes: Apert, Pfeiffer, Crouzon, Jackson-Weiss, Beare-Stevenson and Saethre-Chotzen. Two new conditions associated with the molecular defect have also been elucidated: Muenke's syndrome and Boston type of craniosynostosis. The variability of the phenotype of these two conditions is particularly wide, including patients with only craniosynostosis, classified as non syndromic cases, or those with cloverleaf skull. A precise phenotype and genotype correlationhas not always been possible because of the great clinical overlap and genetic heterogeneity in this group of disorders. A11 the above syndromes present an autossomal dominant pattern of inheritance, and therefore a patient has a 50% chance of having an affected child. Other patterns of inheritance for craniosynostosis have also been described and therefore it is important to perform a careful examination of each case and family. We present two cases seen at our laborato% one with Crouzon and other with Saethre-Chotzen syndrome, to illustrate the importance of the molecular testing for an accurate diagnosis and genetic counseling

Mandibulofacial Dysostosis, Severe Lower Eyelid Coloboma, Cleft Palate, and Alopecia: A New Distinct Form of Mandibulofacial Dysostosis or a Severe Form of Johnson-McMillin Syndrome?

We describe a patient with a phenotype characterized by mandibulofacial dysostosis with severe lower eyelid coloboma, cleft palate, abnormal ears, alopecia, delayed eruption and crowded teeth, and sensorioneural hearing loss. The karyotype and the screening for mutations in the coding region of TCOF1 gene were normal. The clinical signs of our case overlap the new mandibulofacial dysostosis described by Stevenson et al. [2007] and the case with Johnson-McMillin syndrome described by Cushman et al. [2005]. The similar clinical signs, mainly, the severe facial involvement observed in these cases suggest that they can represent a new distinct form of mandibulofacial dysostosis or the end of the spectrum of Johnson McMillin syndrome. (C) 2010 Wiley-Liss, Inc

Frontonasal dysplasia, callosal agenesis, basal encephalocele, and eye anomalies syndrome with a partial 21q22.3 deletion

We describe a girl with a phenotype characterized by frontonasal dysplasia, callosal agenesis, basal encephalocele, and eye anomalies who presents a 46,XX,r(21) karyotype. Array-comparative genomic hybridization using the Afflymetrix 100K DNA oligoarray set showed an interstitial deletion 21q22.3 of approximately 219?kb. Conventional karyotype of both parents was normal, and it was not possible to perform the molecular studies. In this report we raise the hypothesis that the deleted genes located at 21q22.3 could account to the phenotype. (C) 2012 Wiley Periodicals, Inc.CNPqCNPq [301789/2009-6, 302712/2010-0

Carpenter Syndrome: Extended RAB23 Mutation Spectrum and Analysis of Nonsense-mediated mRNA Decay

Carpenter syndrome, a rare autosomal recessive disorder characterized by a combination of craniosynostosis, polysyndactyly, obesity, and other congenital malformations, is caused by mutations in RAB23, encoding a member of the Rab-family of small GTPases. In 15 out of 16 families previously reported, the disease was caused by homozygosity for truncating mutations, and currently only a single missense mutation has been identified in a compound heterozygote. Here, we describe a further 8 independent families comprising 10 affected individuals with Carpenter syndrome, who were positive for mutations in RAB23. We report the first homozygous missense mutation and in-frame deletion, highlighting key residues for RAB23 function, as well as the first splice-site mutation. Multi-suture craniosynostosis and polysyndactyly have been present in all patients described to date, and abnormal external genitalia have been universal in boys. High birth weight was not evident in the current group of patients, but further evidence for laterality defects is reported. No genotype-phenotype correlations are apparent. We provide experimental evidence that transcripts encoding truncating mutations are subject to nonsense-mediated decay, and that this plays an important role in the pathogenesis of many RAB23 mutations. These observations refine the phenotypic spectrum of Carpenter syndrome and offer new insights into molecular pathogenesis

Saethre-Chotzen phenotype with learning disability and hyper IgE phenotype in a patient due to complex chromosomal rearrangement involving chromosomes 3 and 7

The authors describe on a Brazilian girl with coronal synostosis, facial asymmetry, ptosis, brachydactyly, significant learning difficulties, recurrent scalp infections with marked hair loss, and elevated serum immunoglobulin E. Standard lymphocyte karyotype showed a small additional segment in 7p21[46,XX,add(7)(p21)]. Deletion of the TWIST1 gene, detected by Multiplex Ligation Probe-dependent Amplification (MPLA) and array-CGH, was consistent with phenotype of SaethreChotzen syndrome. Array CGH also showed deletion of four other genes at 7p21.1 (SNX13, PRPS1L1, HD9C9, and FERD3L) and the deletion of six genes (CACNA2D2, C3orf18, HEMK1, CISH, MAPKAPK3, and DOCK3) at 3p21.31. Our case reinforces FERD3L as candidate gene for intellectual disability and suggested that genes located in 3p21.3 can be related to hyper IgE phenotype. (C) 2012 Wiley Periodicals, Inc.CNPqCNPq [301789/2009-6]FAPESPFAPES

Using a combination of MLPA kits to detect chromosomal imbalances in patients with multiple congenital anomalies and mental retardation is a valuable choice for developing countries

Conventional karyotyping detects anomalies in 3-15% of patients with multiple congenital anomalies and mental retardation (MCA/MR). Whole-genome array screening (WGAS) has been consistently suggested as the first choice diagnostic test for this group of patients, but it is very costly for large-scale use in developing countries. We evaluated the use of a combination of Multiplex Ligation-dependent Probe Amplification (MLPA) kits to increase the detection rate of chromosomal abnormalities in MCA/MR patients. We screened 261 MCA/MR patients with two subtelomeric and one microdeletion kits. This would theoretically detect up to 70% of all submicroscopic abnormalities. Additionally we scored the de Vries score for 209 patients in an effort to find a suitable cut-off for MLPA screening. Our results reveal that chromosomal abnormalities were present in 87 (33.3%) patients, but only 57 (21.8%) were considered causative. Karyotyping detected 15 abnormalities (6.9%), while MLPA identified 54 (20.7%). Our combined MLPA screening raised the total detection number of pathogenic imbalances more than three times when compared to conventional karyotyping. We also show that using the de Vries score as a cutoff for this screening would only be suitable under financial restrictions. A decision analytic model was constructed with three possible strategies: karyotype, karyotype + MLPA and karyotype + WGAS. Karyotype + MLPA strategy detected anomalies in 19.8% of cases which account for 76.45% of the expected yield for karyotype + WGAS. Incremental Cost Effectiveness Ratio (ICER) of MLPA is three times lower than that of WGAS, which means that, for the same costs, we have three additional diagnoses with MLPA but only one with WGAS. We list all causative alterations found, including rare findings, such as reciprocal duplications of regions deleted in Sotos and Williams-Beuren syndromes. We also describe imbalances that were considered polymorphisms or rare variants, such as the new SNP that confounded the analysis of the 22q13.3 deletion syndrome. (C) 2011 Elsevier Masson SAS. All rights reserved.FAPESP (Fundacao de Amparo a Pesquisa do Estado de Sao Paulo)CEPID (Centro de Pesquisa, Inovacao e Difusao)CNPq (Conselho Nacional de Desenvolvimento Cientifico e Tecnologico