Epigenotype-phenotype correlations in Silver-Russell syndrome.

BACKGROUND: Silver-Russell syndrome (SRS) is characterised by intrauterine growth restriction, poor postnatal growth, relative macrocephaly, triangular face and asymmetry. Maternal uniparental disomy (mUPD) of chromosome 7 and hypomethylation of the imprinting control region (ICR) 1 on chromosome 11p15 are found in 5-10% and up to 60% of patients with SRS, respectively. As many features are non-specific, diagnosis of SRS remains difficult. Studies of patients in whom the molecular diagnosis is confirmed therefore provide valuable clinical information on the condition. METHODS: A detailed, prospective study of 64 patients with mUPD7 (n=20) or ICR1 hypomethylation (n=44) was undertaken. RESULTS AND CONCLUSIONS: The considerable overlap in clinical phenotype makes it difficult to distinguish these two molecular subgroups reliably. ICR1 hypomethylation was more likely to be scored as 'classical' SRS. Asymmetry, fifth finger clinodactyly and congenital anomalies were more commonly seen with ICR1 hypomethylation, whereas learning difficulties and referral for speech therapy were more likely with mUPD7. Myoclonus-dystonia has been reported previously in one mUPD7 patient. The authors report mild movement disorders in three further cases. No correlation was found between clinical severity and level of ICR1 hypomethylation. Use of assisted reproductive technology in association with ICR1 hypomethylation seems increased compared with the general population. ICR1 hypomethylation was also observed in affected siblings, although recurrence risk remains low in the majority of cases. Overall, a wide range of severity was observed, particularly with ICR1 hypomethylation. A low threshold for investigation of patients with features suggestive, but not typical, of SRS is therefore recommended.

Clinical and molecular delineation of the 17q21.31 microdeletion syndrome.

BACKGROUND: The chromosome 17q21.31 microdeletion syndrome is a novel genomic disorder that has originally been identified using high resolution genome analyses in patients with unexplained mental retardation. AIM: We report the molecular and/or clinical characterisation of 22 individuals with the 17q21.31 microdeletion syndrome. RESULTS: We estimate the prevalence of the syndrome to be 1 in 16,000 and show that it is highly underdiagnosed. Extensive clinical examination reveals that developmental delay, hypotonia, facial dysmorphisms including a long face, a tubular or pear-shaped nose and a bulbous nasal tip, and a friendly/amiable behaviour are the most characteristic features. Other clinically important features include epilepsy, heart defects and kidney/urologic anomalies. Using high resolution oligonucleotide arrays we narrow the 17q21.31 critical region to a 424 kb genomic segment (chr17: 41046729-41470954, hg17) encompassing at least six genes, among which is the gene encoding microtubule associated protein tau (MAPT). Mutation screening of MAPT in 122 individuals with a phenotype suggestive of 17q21.31 deletion carriers, but who do not carry the recurrent deletion, failed to identify any disease associated variants. In five deletion carriers we identify a <500 bp rearrangement hotspot at the proximal breakpoint contained within an L2 LINE motif and show that in every case examined the parent originating the deletion carries a common 900 kb 17q21.31 inversion polymorphism, indicating that this inversion is a necessary factor for deletion to occur (p<10(-5)). CONCLUSION: Our data establish the 17q21.31 microdeletion syndrome as a clinically and molecularly well recognisable genomic disorder.

Msx homeobox genes inhibit differentiation through upregulation of cyclin D1.

During development, patterning and morphogenesis of tissues are intimately coordinated through control of cellular proliferation and differentiation. We describe a mechanism by which vertebrate Msx homeobox genes inhibit cellular differentiation by regulation of the cell cycle. We show that misexpression of Msx1 via retroviral gene transfer inhibits differentiation of multiple mesenchymal and epithelial progenitor cell types in culture. This activity of Msx1 is associated with its ability to upregulate cyclin D1 expression and Cdk4 activity, while Msx1 has minimal effects on cellular proliferation. Transgenic mice that express Msx1 under the control of the mouse mammary tumor virus long terminal repeat (MMTV LTR) display impaired differentiation of the mammary epithelium during pregnancy, which is accompanied by elevated levels of cyclin D1 expression. We propose that Msx1 gene expression maintains cyclin D1 expression and prevents exit from the cell cycle, thereby inhibiting terminal differentiation of progenitor cells. Our model provides a framework for reconciling the mutant phenotypes of Msx and other homeobox genes with their functions as regulators of cellular proliferation and differentiation during embryogenesis.

The spectrum of Silver-Russell syndrome: a clinical and molecular genetic study and new diagnostic criteria.

The Silver-Russell syndrome (SRS) is characterised by severe intrauterine growth retardation, with a preserved head circumference, leading to a lean body habitus and short stature. Facial dysmorphism and asymmetry are considered typical features of the syndrome, although the range of phenotypic variance is unknown. Fifty seven subjects varying in age from 0.84 to 35.01 years, in whom the diagnosis of SRS had been considered definite or likely, were re-evaluated in a combined clinical and molecular study by a single observer (SMP). In 50 patients the clinical findings complied with a very broad definition of SRS. Notable additional findings included generalised camptodactyly seen in 11 (22%), many with distal arthrogryposis. Thirteen of the 25 males required genital surgery for conditions including hypospadias and inguinal hernia. Fourteen (36.8%) subjects above school age have received a statement of special educational needs. Molecular genetic analysis was performed in 42 subjects and has identified maternal uniparental disomy of chromosome 7 in four. The phenotype was generally milder with birth weights for one patient above and three below -2 SD from the mean. Two children had classical facial dysmorphic features, and two had a milder facial phenotype. Of relevance to the possible molecular mechanism underlying this condition, none of the four disomic patients had significant asymmetry.

Conserved requirement for EGF-CFC genes in vertebrate left-right axis formation.

Specification of the left-right (L-R) axis in the vertebrate embryo requires transfer of positional information from the node to the periphery, resulting in asymmetric gene expression in the lateral plate mesoderm. We show that this activation of L-R lateral asymmetry requires the evolutionarily conserved activity of members of the EGF-CFC family of extracellular factors. Targeted disruption of murine Cryptic results in L-R laterality defects including randomization of abdominal situs, hyposplenia, and pulmonary right isomerism, as well as randomized embryo turning and cardiac looping. Similarly, zebrafish one-eyed pinhead (oep) mutants that have been rescued partially by mRNA injection display heterotaxia, including randomization of heart looping and pancreas location. In both Cryptic and oep mutant embryos, L-R asymmetric expression of Nodal/cyclops, Lefty2/antivin, and Pitx2 does not occur in the lateral plate mesoderm, while in Cryptic mutants Lefty1 expression is absent from the prospective floor plate. Notably, L-R asymmetric expression of Nodal at the lateral edges of the node is still observed in Cryptic mutants, indicating that L-R specification has occurred in the node but not the lateral plate. Combined with the previous finding that oep is required for nodal signaling in zebrafish, we propose that a signaling pathway mediated by Nodal and EGF-CFC activities is essential for transfer of L-R positional information from the node.

Genetics of Silver-Russell syndrome.

The Silver-Russell syndrome (SRS) is generally sporadic, but with sufficient reported cases of dominant and recessive patterns of inheritance to suggest a genetic cause in some cases, at least. No consistent cytogenetic abnormalities have been found although some features of the syndrome have been reported to be associated with structural abnormalities of distal 15q. More recently it has been shown that about 10% of SRS patients have maternal uniparental disomy of chromosome 7 which suggests the presence of a maternally imprinted gene on chromosome 7 that is associated with SRS. In the majority of patients with normal biparental inheritance of chromosome 7 the same gene could be involved if the paternal copy were deleted or mutated so that it is disabled and the maternal copy is silent because of the imprinting.

Four cases of amelia of the upper limb associated with anal atresia--is this VACTERL with extreme limb involvement?

Amelia is an extremely rare abnormality with a highest reported incidence of 1 in 67,500 liveborn infants. We now report four cases in each of which amelia involving one upper limb occurred in association with anal atresia. The pattern of other abnormalities present in these cases suggests that this combination of amelia and anal atresia falls within the spectrum of the VACTERL association.

Maternal uniparental disomy 7 in Silver-Russell syndrome.

Silver-Russell syndrome (SRS) is characterised by intrauterine and postnatal growth failure accompanied by a variable number of dysmorphic features. It is usually sporadic although a few familial cases have been described. In a prospective study of 33 patients with sporadic SRS, we have studied the parent of origin of chromosome 7 using variable number tandem repeat (VNTR) or microsatellite repeat markers and have identified two patients with maternal uniparental disomy of chromosome 7 (mUPD7). In one family, inconsistent inheritance of paternal alleles of markers on chromosomes other than 7 led to their exclusion from further study. The probands were clinically mild and symmetrical, but showed no gross clinical differences from the 30 patients with chromosome 7 derived from both parents.

Familial exudative vitreoretinopathy linked to D11S533 in a large Asian family with consanguinity.

Familial exudative vitreoretinopathy (FEVR) is a disorder characterised by peripheral retinal vascularisation with subsequent traction of retinal vessels and detachment. Recently, autosomal dominant FEVR (ad FEVR) has been mapped to 11q13 by linkage in four northern European families. We describe a large consanguineous Asian family in which the severity of the proband's eye disease suggested homozygosity for a disease allele. Thirty family members were assessed by ophthalmological examination and fluorescein angiography. Thirteen had unequivocal features of FEVR. A further two were classified as unknown. Two point linkage analysis for DIIS533 and FEVR generated a lod score of 5.55 at a recombination fraction of 0.00. This supports autosomal dominant inheritance and demonstrates genetic homogeneity for the ad FEVR disease locus. The severely affected proband was heterozygous for alleles at this closely linked locus. Other causes, including non-genetic factors, should be considered to explain the extreme variability characteristic of ad FEVR.

The attitudes of midwives to maternal serum screening for Down's syndrome.

An anonymous questionnaire was sent to determine the opinions and attitudes of 342 Leicestershire midwives who are responsible for counselling antenatal patients about maternal serum screening for Down's syndrome. This asked questions regarding grade, background training, attitudes towards testing for spina bifida and Down's syndrome, and opinions upon termination of pregnancy for these and other conditions. A total of 188 (55%) midwives completed the questionnaire. In all, 40.4% of midwives admitted that they did not feel confident counselling for the serum screening test for Down's syndrome; 38.3% of midwives did not feel termination of pregnancy for Down's syndrome was justified; 25% of midwives admitted that they were not in favour of this prenatal test. In conclusion, if such a screening programme is to be introduced across the UK, more attention must be paid in advance to the views and training requirements of those midwives who will be associated with the test. It should not be assumed that ethical considerations, relating to a prenatal test, are of minor significance to those health care professionals involved in its implementation.

Circulating high molecular weight IgG fibronectin complexes in myeloproliferative disorders.

The plasma of patients with myeloproliferative diseases was examined by polyethylene glycol (PEG) precipitation, analytical ultracentrifugation, and immunoaffinity chromatography for the presence of high molecular weight complexes of IgG and fibronectin. Abnormal circulating high molecular weight material was identified by ultracentrifugation in all patients. This was precipitated by PEG and was shown by exclusion chromatography to contain IgG in a high molecular weight form. Examination of plasma by immunoaffinity chromatography supported previous evidence for complex formation between IgG and fibronectin. These findings are further evidence that abnormal high molecular weight IgG complexes are a prominent feature of myeloproliferative disorders and implicate IgG fibronectin complex formation.

A reversible defect of platelet PDGF content in myeloproliferative disorders.

Platelet PDGF (platelet derived growth factor), platelet associated IgG and plasma levels of circulating immune complexes were measured in patients with chronic myeloproliferative disorders (primary myelofibrosis, primary proliferative polycythaemia and essential thrombocythaemia). Platelet PDGF was low in 11/12 patients, immune complexes were elevated in 11/16, and PlAIgG was elevated in all 14 patients in whom it was measured. There was no significant correlation between platelet PDGF and plasma levels of immune complexes (r = -0.5, P greater than 0.1). Treatment with busulphan and prednisolone for 2-3 months restored normal levels of platelet PDGF and suppressed plasma immune complex levels. Plasmapheresis lowered levels of immune complexes but had no effect on platelet PDGF. These results indicate that the low platelet PDGF levels in chronic myeloproliferative disorders represent a reversible defect which is not directly related to the presence of immune complexes.

Composition of immune complexes and their relation to plasma fibronectin in chronic myeloproliferative disorders.

High concentrations of circulating immune complexes were detected by polyethylene glycol precipitation in 11 of 20 patients with myelofibrosis secondary to chronic myeloproliferative disease. Circulating immune complexes showed a positive correlation with plasma IgG concentrations both in patients and controls. Covariance analysis of the two groups showed significantly increased polyethylene glycol precipitable IgG in patients when adjusted for plasma IgG concentrations, indicating that the patients had significantly increased concentrations of complexed IgG. The immune complexes contained IgG, C3, and fibronectin and were inversely correlated with plasma fibronectin concentrations, suggesting that this major non-specific opsonin is important for the normal clearance of immune complexes. Therapeutic plasmapheresis efficiently removed circulating complexes and produced an increase in plasma fibronectin. This suggests that plasmapheresis may be useful for controlling immune complex mediated complications of these disorders.

Screening biological samples for underivatized drugs using a splitless injection technique on fused silica capillary column gas chromatography.

A rapid screening technique is presented for the detection of underivatized drugs using a multi-level temperature program. This allowed for the identification of major clinically significant drugs extracted from serum, urine, and other body fluids. Acidic or basic extractions are injected into a gas chromatograph equipped with a flame ionization detector and a single wide-bore, thick film capillary using the splitless mode of injection. Identification is by retention time relative to that of a common internal standard. Deactivation of the fused silica liner is necessary to consistently detect low concentrations of specific drugs.

Gastrict carcinoma with pseudohyperparathyroidism in a horse.

Pseudohyperparathyroidism was diagnosed in a mature stallion presented for anorexia, weight loss, pollakiuria and constipation. Laboratory findings included hypercalcemia, hypophosphatemia, anemia and isosthenuria. Thoracocentesis indicated an exfoliating squamous cell carcinoma. At necropsy, a squamous cell carcinoma of the stomach with metastases to the abdominal and thoracic cavities was diagnosed. No osseous metastases were found. No gross or microscopic renal lesions were noted. Bone tissue showed arrested resorption, and the parathyroid gland was atrophic.

Allergic contact dermatitis due to N,N-dimethyl-para-phenylenediamine in bacteriology technicians.

Three cases of allergic contact dermatitis due to N,N-dimethyl-para-phenylenediamine in a bacteriology laboratory are presented. This chemical, a dye closely related to the common contact allergen para-phenylenediamine, is used in laboratories to screen bacterial culture plates for Neisseria gonorrhoeae. The three patients had strongly positive patch test reactions to N,N-dimethyl-para-phenylenediamine, but had negative reactions to para-phenylenediamine. A brief discussion of allergic contact cross-sensitization among compounds with the para-aminophenyl grouping is presented.

New world leishmaniasis. Serologic aids to diagnosis.

The increase in travel to endemic areas of South and Central America has led to an increase in the number of cases of cutaneous leishmaniasis diagnosed in the United States. Traditional methods of diagnosis for this disease include microscopical examination of infected tissue, culture of Leishmania on special media, and the leishmanin skin test. The present communication describes a case of cutaneous leishmaniasis and the difficulties that were encountered in diagnosis. New methods of serologic testing allow more prompt and accurate diagnosis.

Barbers' interdigital hair sinus.

A dog groomer developed extensive interdigital sinus formation. Results of examination of 11 other dog groomers suggest that the disease is uncommon in this profession.