ABSTRACT
The evaluation of facial dysmorphism is a critical step toward reaching a diagnostic. The aim of the present study was to evaluate the ability to interpret facial morphology in African children with intellectual disability (ID). First, 10 experienced clinicians (five from Africa and five from Europe) rated gestalt in 127 African non-Down Syndrome (non-DS) patients using either the score 2 for 'clearly dysmorphic', 0 for 'clearly non dysmorphic' or 1 for 'uncertain'. The inter-rater agreement was determined using kappa coefficient. There was only fair agreement between African and European raters (kappa-coefficient = 0.29). Second, we applied the FDNA Face2Gene solution to assess Down Syndrome (DS) faces. Initially, Face2Gene showed a better recognition rate for DS in Caucasian (80%) compared to African (36.8%). We trained the Face2Gene with a set of African DS and non-DS photographs. Interestingly, the recognition in African increased to 94.7%. Thus, training improved the sensitivity of Face2Gene. Our data suggest that human based evaluation is influenced by ethnic background of the evaluator. In addition, computer based evaluation indicates that the ethnic of the patient also influences the evaluation and that training may increase the detection specificity for a particular ethnic.
Subject(s)
Abnormalities, Multiple/diagnosis , Craniofacial Abnormalities/diagnosis , Down Syndrome/diagnosis , Image Processing, Computer-Assisted , Intellectual Disability/diagnosis , Muscular Atrophy/diagnosis , Abnormalities, Multiple/epidemiology , Abnormalities, Multiple/physiopathology , Adolescent , Adult , Black People , Child , Child, Preschool , Craniofacial Abnormalities/epidemiology , Craniofacial Abnormalities/physiopathology , Down Syndrome/epidemiology , Down Syndrome/physiopathology , Face/diagnostic imaging , Face/physiopathology , Female , Humans , Infant , Intellectual Disability/epidemiology , Intellectual Disability/physiopathology , Male , Muscular Atrophy/epidemiology , Muscular Atrophy/physiopathology , Musculoskeletal Abnormalities/diagnosis , Musculoskeletal Abnormalities/epidemiology , Musculoskeletal Abnormalities/physiopathology , White People , Young AdultABSTRACT
Dysmorphology concerns the recognition and management of rare, multiple anomaly syndromes. Genomic technologies and software for gestalt recognition will re-shape dysmorphology services. In order to reflect on a model of the service in the post-genomic era, we compared the utility of dysmorphology consultations in two Mediterranean cities, Athens, Greece and Afula, Israel (MDS), the Manchester Centre for Genomic Medicine, a UK service with dysmorphology expertise (UKDS) and the DYSCERNE, digital service (DDS). We show that it is more likely that chromosome microarray analysis will be performed if suggested in the UKDS rather than in the MDS; this, most probably reflects the difference of access to genetic testing following funding limitations in the MDS. We also show that in terms of achieved diagnosis, the first visit to a dysmorphology clinic is more significant than a follow-up. We show that a confirmed syndrome diagnosis significantly decreases the requests for other, non-genetic, laboratory investigations. Conversely, it increases the requests for reviews by other specialists and, most significantly (t-test: 8.244), it increases further requests for screening for possible associated complications. This is the first demonstration of the demands, on a health service, following the diagnosis of a dysmorphic condition.
Subject(s)
Abnormalities, Multiple/diagnosis , Abnormalities, Multiple/genetics , Disease Management , Genetic Counseling , Genetic Testing , Genetics, Medical/methods , Genetics, Medical/trends , Humans , Practice Patterns, Physicians'/trendsABSTRACT
We describe seven patients with KDM6A (located on Xp11.3 and encodes UTX) mutations, a rare cause of Kabuki syndrome (KS2, MIM 300867) and report, for the first time, germ-line missense and splice-site mutations in the gene. We demonstrate that less than 5% cases of Kabuki syndrome are due to KDM6A mutations. Our work shows that similar to the commoner Type 1 Kabuki syndrome (KS1, MIM 147920) caused by KMT2D (previously called MLL2) mutations, KS2 patients are characterized by hypotonia and feeding difficulties during infancy and poor postnatal growth and short stature. Unlike KS1, developmental delay and learning disability are generally moderate-severe in boys but mild-moderate in girls with KS2. Some girls may have a normal developmental profile. Speech and cognition tend to be more severely affected than motor development. Increased susceptibility to infections, join laxity, heart, dental and ophthalmological anomalies are common. Hypoglycaemia is more common in KS2 than in KS1. Facial dysmorphism with KDM6A mutations is variable and diagnosis on facial gestalt alone may be difficult in some patients. Hypertrichosis, long halluces and large central incisors may be useful clues to an underlying KDM6A mutation in some patients.
Subject(s)
Abnormalities, Multiple/diagnosis , Abnormalities, Multiple/genetics , Face/abnormalities , Genes, X-Linked , Hematologic Diseases/diagnosis , Hematologic Diseases/genetics , Histone Demethylases/genetics , Mutation , Nuclear Proteins/genetics , Vestibular Diseases/diagnosis , Vestibular Diseases/genetics , Amino Acid Substitution , Child , Child, Preschool , Exons , Facies , Female , Gene Order , Genetic Association Studies , Humans , Male , Mutation Rate , Phenotype , Reproducibility of Results , Sequence Analysis, DNAABSTRACT
Kabuki syndrome (KS) is a rare multi-system disorder that can result in a variety of congenital malformations, typical dysmorphism and variable learning disability. It is caused by MLL2 point mutations in the majority of the cases and, rarely by deletions involving KDM6A. Nearly one third of cases remain unsolved. Here, we expand the known genetic basis of KS by presenting five typical patients with the condition, all of whom have novel MLL2 mutation types- two patients with mosaic small deletions, one with a mosaic whole-gene deletion, one with a multi-exon deletion and one with an intragenic multi-exon duplication. We recommend MLL2 dosage studies for all patients with typical KS, where traditional Sanger sequencing fails to identify mutations. The prevalence of such MLL2 mutations in KS may be comparable with deletions involving KDM6A. These findings may be helpful in understanding the mutational mechanism of MLL2 and the disease mechanism of KS.
Subject(s)
Abnormalities, Multiple/genetics , DNA-Binding Proteins/genetics , Gene Deletion , Gene Duplication , Hematologic Diseases/genetics , Mosaicism , Mutation , Neoplasm Proteins/genetics , Vestibular Diseases/genetics , Abnormalities, Multiple/diagnosis , Base Sequence , Child , Child, Preschool , Face/abnormalities , Facies , Female , Genotype , Hematologic Diseases/diagnosis , Humans , Male , Phenotype , Vestibular Diseases/diagnosisABSTRACT
BACKGROUND: Holoprosencephaly (HPE) is the most common structural malformation of the human forebrain. There are several important HPE mutational target genes, including the transcription factor SIX3, which encodes an early regulator of Shh, Wnt, Bmp and Nodal signalling expressed in the developing forebrain and eyes of all vertebrates. OBJECTIVE: To characterise genetic and clinical findings in patients with SIX3 mutations. METHODS: Patients with HPE and their family members were tested for mutations in HPE-associated genes and the genetic and clinical findings, including those for additional cases found in the literature, were analysed. The results were correlated with a mutation-specific functional assay in zebrafish. RESULTS: In a cohort of patients (n = 800) with HPE, SIX3 mutations were found in 4.7% of probands and additional cases were found through testing of relatives. In total, 138 cases of HPE were identified, 59 of whom had not previously been clinically presented. Mutations in SIX3 result in more severe HPE than in other cases of non-chromosomal, non-syndromic HPE. An over-representation of severe HPE was found in patients whose mutations confer greater loss of function, as measured by the functional zebrafish assay. The gender ratio in this combined set of patients was 1.5:1 (F:M) and maternal inheritance was almost twice as common as paternal. About 14% of SIX3 mutations in probands occur de novo. There is a wide intrafamilial clinical range of features and classical penetrance is estimated to be at least 62%. CONCLUSIONS: Our data suggest that SIX3 mutations result in relatively severe HPE and that there is a genotype-phenotype correlation, as shown by functional studies using animal models.
Subject(s)
Eye Proteins/genetics , Holoprosencephaly/genetics , Homeodomain Proteins/genetics , Nerve Tissue Proteins/genetics , Chi-Square Distribution , Cohort Studies , DNA Mutational Analysis , Female , Holoprosencephaly/diagnosis , Holoprosencephaly/physiopathology , Humans , Male , Mutation , Penetrance , Phenotype , Sex Factors , Homeobox Protein SIX3ABSTRACT
We report a series of eight patients with the Say/Barber/Biesecker/Young-Simpson (SBBYS) type of Ohdo syndrome, which is the largest cohort described to date. We expand on the type, frequency and severity of the clinical characteristics in this condition; comment on the natural history of Ohdo syndrome and further refine previously published diagnostic criteria. Cytogenetic investigations and microarray CGH analysis undertaken in this cohort of patients failed to identify a chromosomal aetiology. It remains possible that this rare condition is heterogeneous and therefore caution must be undertaken during counselling until the underlying genetic mechanism(s) is (are) identified.
Subject(s)
Abnormalities, Multiple/diagnosis , Learning Disabilities/diagnosis , Abnormalities, Multiple/genetics , Adolescent , Blepharophimosis/pathology , Child , Cohort Studies , Cytogenetic Analysis , Developmental Disabilities/pathology , Diagnosis, Differential , Humans , Learning Disabilities/genetics , Limb Deformities, Congenital/pathology , Phenotype , SyndromeABSTRACT
We report fluorescence in situ hybridization (FISH) mapping of 152, mostly de novo, apparently balanced chromosomal rearrangement (ABCR) breakpoints in 76 individuals, 30 of whom had no obvious phenotypic abnormality (control group) and 46 of whom had an associated disease (case group). The aim of this study was to identify breakpoint characteristics that could discriminate between these groups and which might be of predictive value in de novo ABCR (DN-ABCR) cases detected antenatally. We found no difference in the proportion of breakpoints that interrupted a gene, although in three cases, direct interruption or deletion of known autosomal-dominant or X-linked recessive Mendelian disease genes was diagnostic. The only significant predictor of phenotypic abnormality in the group as a whole was the localization of one or both breakpoints to an R-positive (G-negative) band with estimated predictive values of 0.69 (95% CL 0.54-0.81) and 0.90 (95% CL 0.60-0.98), respectively. R-positive bands are known to contain more genes and have a higher guanine-cytosine (GC) content than do G-positive (R-negative) bands; however, whether a gene was interrupted by the breakpoint or the GC content in the 200 kB around the breakpoint had no discriminant ability. Our results suggest that the large-scale genomic context of the breakpoint has prognostic utility and that the pathological mechanism of mapping to an R-band cannot be accounted for by direct gene inactivation.
Subject(s)
Chromosome Aberrations , Chromosome Mapping , Genetic Diseases, Inborn/diagnosis , In Situ Hybridization, Fluorescence , Case-Control Studies , Humans , Phenotype , Prognosis , Sequence DeletionABSTRACT
BACKGROUND: Costello syndrome (CS) is a rare multiple congenital abnormality syndrome, associated with failure to thrive and developmental delay. One of the more distinctive features in childhood is the development of facial warts, often nasolabial and in other moist body surfaces. Individuals with CS have an increased risk of malignancy, suggested to be about 17%. Recently, mutations in the HRAS gene on chromosome 11p13.3 have been found to cause CS. METHODS: We report here the results of HRAS analysis in 43 individuals with a clinical diagnosis of CS. RESULTS: Mutations were found in 37 (86%) of patients. Analysis of parental DNA samples was possible in 16 cases for both parents and in three cases for one parent, and confirmed the mutations as de novo in all of these cases. Three novel mutations (G12C, G12E, and K117R) were found in five cases. CONCLUSIONS: These results confirm that CS is caused, in most cases, by heterozygous missense mutations in the proto-oncogene HRAS. Analysis of the major phenotypic features by mutation suggests a potential correlation between malignancy risk and genotype, which is highest for patients with an uncommon (G12A) substitution. These results confirm that mutation testing for HRAS is a reliable diagnostic test for CS.
Subject(s)
Abnormalities, Multiple/diagnosis , Proto-Oncogene Proteins p21(ras)/genetics , Abnormalities, Multiple/genetics , Adolescent , Adult , Child , Child, Preschool , DNA Mutational Analysis , Diagnosis, Differential , Female , Genotype , Humans , Infant , Intracellular Signaling Peptides and Proteins/genetics , Noonan Syndrome/diagnosis , Noonan Syndrome/genetics , Phenotype , Protein Tyrosine Phosphatase, Non-Receptor Type 11 , Protein Tyrosine Phosphatases/genetics , Proto-Oncogene Mas , SyndromeABSTRACT
BACKGROUND: CHARGE syndrome is a non-random clustering of congenital anomalies including coloboma, heart defects, choanal atresia, retarded growth and development, genital hypoplasia, ear anomalies, and deafness. A consistent feature in CHARGE syndrome is semicircular canal hypoplasia resulting in vestibular areflexia. Other commonly associated congenital anomalies are facial nerve palsy, cleft lip/palate, and tracheo-oesophageal fistula. Specific behavioural problems, including autistic-like behaviour, have been described. The CHD7 gene on chromosome 8q12.1 was recently discovered as a major gene involved in the aetiology of this syndrome. METHODS: The coding regions of CHD7 were screened for mutations in 107 index patients with clinical features suggestive of CHARGE syndrome. Clinical data of the mutation positive patients were sampled to study the phenotypic spectrum of mutations in the CHD7 gene. RESULTS: Mutations were identified in 69 patients. Here we describe the clinical features of 47 of these patients, including two sib pairs. Most mutations were unique and were scattered throughout the gene. All patients but one fulfilled the current diagnostic criteria for CHARGE syndrome. No genotype-phenotype correlations were apparent in this cohort, which is best demonstrated by the differences in clinical presentation in sib pairs with identical mutations. Somatic mosaicism was detected in the unaffected mother of a sib pair, supporting the existence of germline mosaicism. CONCLUSIONS: CHD7 mutations account for the majority of the cases with CHARGE syndrome, with a broad clinical variability and without an obvious genotype-phenotype correlation. In one case evidence for germline mosaicism was provided.
Subject(s)
Abnormalities, Multiple/diagnosis , Abnormalities, Multiple/genetics , DNA Helicases/genetics , DNA-Binding Proteins/genetics , Mutation , Adolescent , Adult , Central Nervous System Diseases/diagnosis , Central Nervous System Diseases/genetics , Child , Child, Preschool , Choanal Atresia/diagnosis , Choanal Atresia/genetics , Coloboma/diagnosis , Coloboma/genetics , DNA Mutational Analysis , Female , Genetic Testing , Gestational Age , Heart Defects, Congenital/diagnosis , Heart Defects, Congenital/genetics , Humans , Infant , Infant, Newborn , Male , Mouth Diseases/diagnosis , Mouth Diseases/genetics , Phenotype , Spinal Diseases/diagnosis , Spinal Diseases/genetics , Syndrome , Vestibular Diseases/diagnosis , Vestibular Diseases/geneticsABSTRACT
Kohlschutter syndrome is a rare neurodegenerative disorder presenting with intractable seizures, developmental regression and characteristic hypoplastic dental enamel indicative of amelogenesis imperfecta. We report a new family with two affected siblings.
Subject(s)
Abnormalities, Multiple/pathology , Amelogenesis Imperfecta/pathology , Dental Enamel Hypoplasia/pathology , Developmental Disabilities/pathology , Epilepsy/pathology , Abnormalities, Multiple/genetics , Adolescent , Cerebellum/abnormalities , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Male , Siblings , SyndromeABSTRACT
We report two unrelated children with Filippi syndrome. Both show typical facial dysmorphism, syndactyly of fingers and toes, growth retardation, postnatal microcephaly and developmental delay, particularly involving speech. In addition both children have unusual teeth and hair. We review the literature and propose that neurological and ectodermal involvement may be under-recognised features of the syndrome.
Subject(s)
Facies , Hair/abnormalities , Microcephaly/physiopathology , Syndactyly/physiopathology , Tooth Abnormalities/physiopathology , Adolescent , Child, Preschool , Developmental Disabilities/physiopathology , Humans , Infant , Infant, Newborn , Male , SyndromeSubject(s)
Abnormalities, Multiple/genetics , Connexin 43/genetics , Craniofacial Abnormalities/genetics , Eye Abnormalities/genetics , Fingers/abnormalities , Gene Expression Regulation, Developmental/genetics , Syndactyly/genetics , Tooth Abnormalities/genetics , Amino Acid Sequence/genetics , Animals , Cattle , Connexin 43/chemistry , Connexin 43/physiology , Cricetinae , Embryo, Mammalian/chemistry , Embryo, Mammalian/metabolism , Gene Expression Regulation, Developmental/physiology , Humans , Mice , Molecular Sequence Data , Mutation, Missense/genetics , Phenotype , Rats , Sequence Alignment , SyndromeABSTRACT
Pax genes are a highly conserved family of developmental control genes that encode transcription factors. In vertebrates, Pax genes play a role in pattern formation during embryogenesis. Mutations in Pax genes have been associated with both spontaneous mouse mutants and congenital human diseases. The mouse Pax1 mutant phenotype undulated is characterised by vertebral segmentation defects reminiscent of the human disorder Klippel-Feil syndrome (KFS). To determine whether PAX1 haploinsufficiency plays a role in KFS, we have defined the gene structure of the human PAX1 gene and screened 63 KFS patients for mutations in this gene. Differences in the PAX1 sequence were detected in eight patients. Two patients had a silent change within the paired box that was also seen in 2/303 control chromosomes. The other variants were missense, silent or intronic changes not represented in the control panel tested. The significance of these results and the possible role of PAX1 in the pathogenesis of KFS are discussed.
Subject(s)
DNA-Binding Proteins/genetics , Genetic Testing , Klippel-Feil Syndrome/genetics , Transcription Factors/genetics , Base Sequence , DNA Mutational Analysis , DNA Primers , Humans , Molecular Sequence Data , Paired Box Transcription Factors , Polymorphism, GeneticSubject(s)
Cataract/genetics , Eye Abnormalities/genetics , Family Health , Translocation, Genetic/genetics , Adult , Age of Onset , Child, Preschool , Facies , Female , Humans , Karyotyping , Male , PedigreeSubject(s)
Chromosome Deletion , Chromosomes, Human, Pair 7/genetics , Williams Syndrome/genetics , Adult , Animals , Cell Line , Child , Chromosome Mapping , Cognition/physiology , Female , Genotype , Humans , Hybrid Cells , Mice , Microsatellite Repeats , Phenotype , Repetitive Sequences, Nucleic Acid/genetics , Williams Syndrome/pathology , Williams Syndrome/physiopathologyABSTRACT
Genetic register services incorporating long term follow up and a proactive approach to at risk subjects have been recommended as a way of improving access to genetic counselling for families with dominant or X linked genetic disorders and chromosome translocations. The aims of the present study were to evaluate the psychosocial benefits and drawbacks of long term family contact, and to evaluate the attitudes of probands and their general practitioners towards proactive genetic counselling. We interviewed 192 people referred to three regional genetic clinics because of a family history of Duchenne or Becker muscular dystrophy, myotonic dystrophy, or chromosome translocations, and 43 of the referring GPs. Probands attending the centre using a genetic register approach were compared with those from the two centres offering the standard clinical genetic service. A very high proportion of probands in both groups were well informed about the genetic risks to themselves and their children, were satisfied with the service they had received from their local genetic clinic, and felt adequately prepared to discuss the family illness with their children. The register probands expressed approval of the ongoing contact and open access provided by the register service. Asked whether previously unaware relatives should be informed of their at risk status, 98% (188/192) said it was acceptable for this information to be disclosed by a family member, while three quarters of the probands (149/192) and just over half the GPs (27/43) thought it acceptable for the genetic service to approach them; a similar proportion of both GPs and probands also found it acceptable for GPs to do so. More than half the probands (107/190) thought it was the family's responsibility to pass on genetic risk information, but 43% said that either the genetic service or the GP should be responsible for this. The findings show that the genetic register approach incorporating long term follow up and a proactive approach to genetic counselling is highly acceptable to the families concerned, and although the register and non-register probands did not differ significantly on any of the main outcome measures used in this relatively short term study, it may be that the continuing contact associated with the register approach offers long term benefits, especially for those genetic conditions where medical surveillance may have an impact on the prognosis.
Subject(s)
Attitude , Genetic Counseling/methods , Genetic Counseling/psychology , Genetic Predisposition to Disease , Referral and Consultation , Registries , Adult , Child , Family Health , Female , Health Education , Humans , Interviews as Topic , Male , Muscular Dystrophies/diagnosis , Muscular Dystrophies/genetics , Nuclear Family , Patient Education as Topic , Patient Satisfaction , Physicians, Family/psychology , Pregnancy , Retrospective Studies , Risk , Time Factors , Translocation, Genetic/genetics , United KingdomABSTRACT
The pedigrees of 192 subjects at risk of Duchenne or Becker muscular dystrophy, myotonic dystrophy, or balanced chromosome translocations attending three regional genetic clinics were inspected to identify relatives who were themselves at high risk of these disorders. Of the 342 relatives eligible for inclusion, 43% (63/147) of the register relatives and 26% (50/195) of the non-register relatives had had contact with the clinical genetic services, a significant difference (p<0.02). Relatives from families with muscular dystrophy were significantly more likely to have been in contact with genetic services than those from BT families. Fifty-two relatives were interviewed about their experience and attitudes regarding genetic counselling. Almost all regarded knowledge about the family genetic disorder as helpful, and only one thought it unacceptable for relatives to be informed that they are at risk; 94% thought it was acceptable for this information to come from family members, 92% from general practitioners, and 90% from the clinical genetic service. A majority of relatives (53%) thought it was the family's responsibility to pass on genetic risk information, but 22% said the genetic service should be responsible and 18% thought it should be the GP. These data, together with the findings from the study of probands attending genetic clinics for these disorders, indicate that the genetic register approach incorporating long term follow up and a proactive approach to genetic counselling is acceptable to the families concerned and improves access to genetic services for at risk relatives.
Subject(s)
Attitude , Family Health , Genetic Counseling/psychology , Genetic Counseling/supply & distribution , Genetic Predisposition to Disease , Health Services Accessibility , Registries , Adult , Child , Female , Genetic Privacy , Health Education , Humans , Interviews as Topic , Male , Muscular Dystrophies/diagnosis , Muscular Dystrophies/genetics , Patient Satisfaction , Pedigree , Pregnancy , Retrospective Studies , Risk , Translocation, Genetic/genetics , United KingdomABSTRACT
Acrocallosal syndrome (ACS) is characterised by postaxial polydactyly, hallux duplication, macrocephaly, and absence of the corpus callosum, usually with severe developmental delay. The condition overlaps with Greig cephalopolysyndactyly syndrome (GCPS), an autosomal dominant disorder that results from mutations in the GLI3 gene. Here we report a child with agenesis of the corpus callosum and severe retardation, both cardinal features of ACS and rare in GCPS, who has a mutation in GLI3. Since others have excluded GLI3 in ACS, we suggest that ACS may represent a heterogeneous group of disorders that, in some cases, may result from a mutation in GLI3 and represent a severe, allelic form of GCPS. The finding is important for counselling families with suspected ACS.
Subject(s)
Abnormalities, Multiple/genetics , Agenesis of Corpus Callosum , DNA-Binding Proteins/genetics , Intellectual Disability/pathology , Nerve Tissue Proteins , Polydactyly/pathology , Repressor Proteins , Transcription Factors/genetics , Xenopus Proteins , Abnormalities, Multiple/pathology , Amino Acid Sequence , Animals , Base Sequence , Child, Preschool , DNA/chemistry , DNA/genetics , DNA Mutational Analysis , Disease Models, Animal , Humans , Kruppel-Like Transcription Factors , Male , Mice , Molecular Sequence Data , Mutation , Phenotype , Sequence Homology, Amino Acid , Sequence Homology, Nucleic Acid , Syndrome , Zinc Finger Protein Gli3ABSTRACT
This is a time of unprecedented increase in knowledge about the genetic basis of disease against a background of rapidly changing technology. Advances happen quickly, with the new knowledge rapidly becoming relevant to services for patients, and hence there is an increasing demand for, and expectation of, genetic services. This brings a challenge for health services worldwide to keep pace with the expectations of their populations. There is also a need for public and professional education and dialogue to dispel some of the hype and myths about what can be achieved. It should not be forgotten that any services must be provided and developed within a broad ethical framework. A statement from a WHO expert consultation (1) concluded that 'Genetic advances will only be acceptable if their application is carried out ethically, with due regard to autonomy, justice, education and the beliefs and resources of each nation and community'. That so many public bodies have commented on genetic services and their associated ethical, legal and social issues emphasizes not only the importance of this area in health care, but also that the wider issues are of great importance in democratic societies. The aim of this paper is to review the current situation in the provision of genetic services, to examine the drivers for change, to speculate on the likely need for future services and to suggest models for the development of such services. Pharmacogenetics and the determination of genetic factors indicating susceptibility to infection will not be discussed since these have been the subject of several recent excellent reviews (2, 3). Genetic services have been defined as health measures implemented to help people with a genetic disadvantage and their families to live and reproduce as normally as possible (4). Broadly they can be divided into those services which target whole populations with a view to identifying those at increased risk; and those which focus on the needs of families which are affected by a genetic disorder or who perceive themselves to be at increased risk.
Subject(s)
Genetic Counseling/standards , Genetic Counseling/trends , Genetic Testing/standards , Genetic Testing/trends , Genetics, Medical/standards , Genetics, Medical/trends , Developing Countries , Genetic Carrier Screening , Genetic Diseases, Inborn/genetics , Genetic Diseases, Inborn/prevention & control , HumansABSTRACT
The human TWIST gene encodes a 202 amino acid transcription factor characterized by a highly conserved basic-helix-loop-helix motif in the C-terminal half, and a less conserved N-terminal half that has binding activity toward the histone acetyltransferase p300. Between these domains is a repeat region of unknown function that encodes the glycine-rich sequence (Gly)5Ala(Gly)5. Heterozygous mutations of TWIST were previously described in Saethre-Chotzen craniosynostosis syndrome [El Ghouzzi et al., 1997; Howard et al., 1997]. During a search for TWIST mutations in patients with craniosynostosis, we identified, in addition to 11 novel and one previously described bona fide mutations, several individuals with rearrangements of the glycine-rich region, involving either deletion of 18 nucleotides or insertion of three, 15, or 21 nucleotides. None of these rearrangements was consistently associated with clinical disease and we conclude that they are at most weakly pathogenic. The glycine stretch may serve as a flexible linker between the functional domains of the TWIST protein, and as such may be subject to reduced evolutionary constraint.