Dermatological manifestations in Noonan syndrome: a prospective multicentric study of 129 patients positive for mutation
BRITISH JOURNAL OF DERMATOLOGY
Authors: Bessis, D.; Miquel, J.; Bourrat, E.; Chiaverini, C.; Morice-Picard, F.; Abadie, C.; Manna, F.; Baumann, C.; Best, M.; Blanchet, P.; Bursztejn, A-C; Capri, Y.; Coubes, C.; Giuliano, F.; Guillaumont, S.; Hadj-Rabia, S.; Jacquemont, M-L; Jeandel, C.; Lacombe, D.; Mallet, S.; Mazereeuw-Hautier, J.; Molinari, N.; Pallure, V; Pernet, C.; Philip, N.; Pinson, L.; Sarda, P.; Sigaudy, S.; Vial, Y.; Willems, M.; Genevieve, D.; Verloes, A.; Cave, H.
Abstract
Background Data on dermatological manifestations of Noonan syndrome (NS) remain heterogeneous and are based on limited dermatological expertise. Objectives To describe the dermatological manifestations of NS, compare them with the literature findings, and test for dermatological phenotype-genotype correlations with or without the presence of PTPN11 mutations. Methods We performed a large 4-year, prospective, multicentric, collaborative dermatological and genetic study. Results Overall, 129 patients with NS were enrolled, including 65 patients with PTPN11-NS, 34 patients with PTPN11-NS with multiple lentigines (NSML), and 30 patients with NS who had a mutation other than PTPN11. Easy bruising was the most frequent dermatological finding in PTPN11-NS, present in 53 center dot 8% of patients. Multiple lentigines and cafe-au-lait macules (n >= 3) were present in 94% and 80% of cases of NSML linked to specific mutations of PTPN11, respectively. Atypical forms of NSML could be associated with NS with RAF1 or NRAS mutations. In univariate analysis, patients without a PTPN11 mutation showed (i) a significantly higher frequency of keratinization disorders (P = 0 center dot 001), including keratosis pilaris (P = 0 center dot 005), ulerythema ophryogenes (P = 0 center dot 0001) and palmar and/or plantar hyperkeratosis (P = 0 center dot 06, trend association), and (ii) a significantly higher frequency of scarce scalp hair (P = 0 center dot 035) and scarce or absent eyelashes (P = 0 center dot 06, trend association) than those with PTPN11 mutations. Conclusions The cutaneous phenotype of NS with a PTPN11 mutation is generally mild and nonspecific, whereas the absence of a PTPN11 mutation is associated with a high frequency of keratinization disorders and hair abnormalities.
Identification of Gene Mutations in Primary Pediatric Cardiomyopathy by Whole Exome Sequencing
PEDIATRIC CARDIOLOGY
Authors: Rojnueangnit, Kitiwan; Sirichongkolthong, Boonchu; Wongwandee, Ratthapon; Khetkham, Thanitchet; Noojarern, Saisuda; Khongkraparn, Arthaporn; Wattanasirichaigoon, Duangrurdee
Abstract
Pediatric primary cardiomyopathy is rare but serious, having high mortality; hypertrophic and dilated types are the most common. Its etiology has been mainly considered idiopathic; however, next generation sequencing techniques have revealed nearly half of idiopathic pediatric cases arose from specific genetic mutations. Therefore, our study aimed to identify the genetic causes of primary idiopathic cardiomyopathy. Newborns to 15-year old patients with this condition were recruited between March 2016 and May 2017 at Thammasat University Hospital. Complete patient history and physical examination data were collected by a geneticist with cardiac examinations and echocardiograms by pediatric cardiologists. Whole exome sequencing was performed for all. Of the 12 patients enrolled, 5 cases were dilated type and 7 hypertrophic. Two with dilated type were excluded during follow-up as cause was determined (hypocalcemia and pacemaker induced). A list of 118 genes for cardiomyopathy was analyzed in the remaining 10 cases. Pathogenic and likely pathogenic mutations were identified in 5 patients: HRAS, PTPN11, SOS1, FLNC and TXNRD2; half our patients were not actually idiopathic. Despite its high cost, genetic testing is useful for determining familial risk as well as predicting patient cardiomyopathy progress.