Mycophenolate mofetil embryopathy may be dose and timing dependent.

Mycophenolate mofetil (MMF) is an immunosuppressive agent that has now been recognized as teratogenic in humans. A pattern of malformations from in utero exposure to MMF has recently been described, and includes cleft lip and palate, microtia and atresia of the external auditory canal. We present a nulliparous mother who had taken MMF for recurrent erythema multiforme for the first 5 weeks of her pregnancy, and developed a spontaneous miscarriage during the seventh week of pregnancy. For her second pregnancy, she took MMF on her own accord for four days in the seventh week after her last menstrual period. The newborn had bilateral microtia, absence of the external auditory canals, and right iris and chorioretinal coloboma, consistent with the pattern recognized as part of the MMF embryopathy phenotype. As the newborn was not exposed to other immunosuppressive agents in utero, we believe that the phenotype described to be the result of the teratogenic effect of MMF. The spontaneous miscarriage in the first pregnancy may be due to the higher dose and longer duration of MMF exposure. The second pregnancy, with MMF exposure of 4 days, proceeded to term with the resultant phenotype. We conclude that the effect and severity of the embryopathy may be dependent on the dose, timing, and duration of MMF exposure. The manufacturer and the United States Food and Drug Administration have now disseminated information regarding the teratogenic risk of MMF. Women should be fully counseled and advised about contraception during the course of treatment with MMF.

Mosaic 13q13.2-ter deletion restricted to tissues of ectodermal and mesodermal origins.

The '13q-' syndrome shows widely variable manifestations. Investigation of the involvement of different tissues has never been reported in patients with 13q- syndrome previously. We describe a patient with mosaicism for del(13q) and clinical features of 13q- syndrome. The mother of the patient was professionally exposed to aniline colorants and glue components during the whole pregnancy. The patient had dysmorphic features, skeletal anomalies and brain malformations with agenesis of the corpus callosum, vermian hypoplasia and IVth ventricular system abnormalities. Eye examination revealed chorioretinal coloboma and irregular dispersion of retinal pigment in the right eye. The karyotype analyses and the molecular studies performed on peripheral lymphocytes, oral swab and cells of urinary tract were normal whereas a deletion of the long arm of chromosome 13 (13q13.2) was found in skin fibroblasts and in hair cells. We hypothesized that the 13q deletion arose during the third week after conception possibly due to a teratogenic effect and that tissue of mesodermal and ectodermal origin are involved. We suggest analysing a fibroblast karyotype when a diagnosis of 13q- syndrome is suspected on clinical ground. The role of teratogens in causing this type of mosaic chromosome abnormality also warrants further investigation.

A population-based case-control study of isolated ocular coloboma.

AIMS: To attempt the detection of possible etiological factors in the origin of isolated ocular, mainly iris coloboma. METHODS: The data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities, 1980-2002, was used. Exposure data and family history were based on (1) prospective medical records, (2) retrospective maternal information, and (3) information obtained by regional nurses at home visit. RESULTS: Of 46 cases, 40 were affected with iris coloboma and 19 had bilateral manifestation. The positive family history indicated a hereditary origin in 4.3% (2/46) of cases. An association was found between the isolated ocular coloboma and hydroxyethylrutoside treatment (adjusted POR with 95% CI: 5.4, 2.2-12.9). Another association was seen between isolated ocular coloboma and hypothyroidism (adjusted OR with 95% CI = 12.6, 3.0-52.7), but it was based only on two cases. CONCLUSIONS: It is necessary to study the preventable environmental factors in the origin of these ocular defects.

Eye malformations associated with treatment with carbamazepine during pregnancy.

Four children are presented and their eye malformations described. One girl had bilateral anophthalmos, a boy and a girl had bilateral severe microphthalmos, and a boy had a unilateral optic disc coloboma. The mothers of all for children were treated with carbamazepine during pregnancy. The teratogenic effect of carbamazepine and its likely role in the genesis of the eye malformations is discussed.

Ocular manifestations of the fetal hydantoin syndrome.

Eleven per cent of infants exposed to hydantoins in utero have a recognizable pattern of abnormalities with serious clinical consequences. This report of a child born to a mother taking diphenylhydantoin emphasized the ocular findings. At birth and subsequent 8-month exam, a girl was noted to have microphthalmus, prominent iris vessels, and an inferior iris and choroidal colobma. Relation of these anomalies to teratogenic properties of diphenylhydantoin is discussed.

[Ocular lesions induced by saccharin and its pollutants in the rat fetus]. / Lésions oculaires provoquées par la saccharine et ses polluants sur les foetus des rats.

The authors analyze and compare the teratogenic effects produced on the embryo eyes of rats by Maumee saccharin, by non purified Remsem saccharin and several pollutants. The study has been made on 2708 embryos of rats whose mothers have received per os several pollutants at several rates; 16 diets have been studied. The histological lesions are described: the cataract, the retinal coloboma, the major microphthalmos, the anophthalmos, the presence of aberrant nervous fibers, the anarchic globes. The authors describe the retinal eversion phenomenon in the retinal coloboma as well as its repercussion on the ocular malformations (retinal dysplasia and colobomatous cyst of the orbit). The presence of aberrant nervous fibers inside the retinal coloboma could explain the cases of double papilla, which were observed in clinic. The major microphthalmia are frequent. The serious anophthalmia are explained by an early perturbation of the embryogenesis. The anarchic globes could be interpreted as a form of congenital cystic eye. Under the different pollutants of the saccharin, four of them are more toxic: it is the ortho-sulfobenzoic acid, the para-sulfobenzoic acid, the para-sulfamolybenzoic acid, the para-toluenesulfonamide which communicate the Remsen saccharin its teratogenic effect. On the other hand, the ortho-toluene sulfonamide is without any teratogenic effect. The authors conclude on the necessity of a large purity of the commercial saccharin.

A case of coloboma in a newborn to a woman taking mycophenolate mofetil in pregnancy after kidney transplantation.

Recently, mycophenolate mofetil (MMF) has been introduced in the immunosuppressive strategy after kidney transplantation. Recently, the existence of a MMF associated embriopathy has been hypothesized, namely, multiple craniofacial malformations. Only 1 report has described chorioretinal coloboma. We report a case of woman who used MMF throughout pregnancy after kidney transplantation. Her newborn developed coloboma of the right eye associated with an ocular cyst without any other malformation. The other drugs used by our patient are not considered teratogenic. Therefore, it seems reasonable to conclude a causal relationship between MMF and the malformation observed in this newborn.

Effects of H-2 and vitamin A on eye defects in congenic mice.

Pregnant mice congenic with C57BL/10 (B10.A, B10.BR, B10.D2, B10.A(2R), B10.A(5R), B10.A(15R), B10.A(1R), B10.A(18R), and B10.OL) were fed Purina Mouse Chow or the same diet plus 200 IU of vitamin A daily. The pregnant dams were sacrificed on the 18th day of gestation and the fetuses were sexed and examined for defects in eye development. It was found that the frequency of microphthalmia and anophthalmia in the female progeny of mice fed Mouse Chow was 7.4-9.2% in B10.A and B10.BR, 4.0-5.5% in B10.A(18R), B10, B10.A(5R), B10.A(1R), B10.A(15R), and B10.A(2R), and 0.8% and 1.4% in B10.D2 and B10.OL mice, respectively. On average, the frequency of these defects in the female progeny was 6.2 times greater than that in males (P less than 0.001). The right eye was 5.8 times more often affected than the left (P less than 0.001). The addition of vitamin A to the diet increased the frequency of these eye abnormalities in all strains, suggesting that this effect is not mediated by loci associated with H-2, as is the case with vitamin A-enhanced cleft palate. The addition of vitamin A to the diet did not affect the ratios of affected males to females, affected right to left eye, or microphthalmia to anophthalmia. The results suggest that there are two loci on chromosome 17, one centromeric to E beta and one telemeric to C4, that interact to determine to some degree the frequency of microphthalmia and anophthalmia.

Defects and disabilities of thalidomide children.

The range of defects and disabilities in thalidomide children is very much wider than is generally realized. The defects of 154 children are described and classified. Their disabilities range from incapacitating to negligible.