Síndrome PAGOD y anomalías vasculares: ¿es un defecto de la angiogénesis embrionaria? Un nuevo caso y revisión / PAGOD syndrome and vascular anomalies: is a defect embryonic angiogenesis? A case report and review

El Síndrome PAGOD es un acrónimo de hipoplasia de pulmón y arterias pulmonares, agonadismo, onfalocele / defecto diafragmático y dextrocardia. Se describe una serie de 21 pacientes, en la cual, 90,5 % presentó un cariotipo 46,XY y solo dos casos 46,XX; el 66,6 % exhibió un fenotipo femenino y 28,6 % genitales ambiguos. La ocurrencia de dos paciente 46,XX excluye al cromosoma Y como portador del defecto genético y plantea la posibilidad de una herencia recesiva ligada al cromosoma X, sin descartar que los casos observados en hermanos puedan deberse a mutaciones en otros genes como STRA6, VEGFA, VEGFB, VEGFC, transcritos de empalmes alternativos de VEGFA, HIF1, HIF2, entre otros. Las malformaciones congénitas observadas en los pacientes fueron: genitales y gónadas 85,7 %, diafragma y pared 66,6 %, cardíaco 80,9 %, pulmonar 71,4 %, vascular 80,9 % y abdomen 42,8 %. La revisión de los pacientes ha demostrado un alto grado de variabilidad en la expresividad de malformaciones de órganos, aparatos o sistemas. Las malformaciones vasculares representan un componente importante y característico del síndrome PAGOD y cuya base morfogenética del síndrome pueda deberse a un defecto de la angiogénesis embrionaria temprana con repercusión en la organogénesis de aparatos y sistemas. Dentro de los genes relacionados con el remodelamiento vascular durante la embriogénesis, regeneración tisular y carcinogénesis está el Factor de Crecimiento del Endotelio Vascular D (VEGFD), localizado en Xp22.31, con expresión en pulmón, corazón, intestino delgado, pulmón fetal, útero, mamas, tejido neural y neuroblastoma, el cual representa un fuerte candidato para su análisis molecular como una de las posibles causa del síndrome.

PAGOD Syndrome is an acronym for lung and pulmonary arteries hypoplasia, agonadism, omphalocele / diaphragmatic defect and dextrocardia. A series of 21 patients is described, where 90.5% had a 46,XY karyotype and only two cases 46,XX; 66.6% exhibited a female phenotype and 28.6% ambiguous genitalia. The occurrence of two patients 46,XX excludes the Y chromosome as a carrier of the genetic defect and raises the possibility of a recessive X-linked inheritance, without ruling out that the observed cases in siblings may be due to mutations in other genes as Stra6, VEGFA, VEGFB, VEGFC, and alternative splicing of transcripts VEGFA, HIF1, HIF2, among others. Congenital malformations were observed in patients’ genitals and gonads 85.7%, 66.6% in diaphragm and abdominal wall , heart 80.9%, 71.4% lungs, blood vessels 80.9% and 42.8% in abdomen. The review of patients has demonstrated a high degree of variability in the expression of malformations of organs and organ systems. Vascular malformations represent an important and characteristic component of PAGOD syndrome and whose base morphogenetic syndrome may be due to a defect in early embryonic angiogenesis with impact on organogenesis and system development. Among genes related to vascular remodeling during embryogenesis, tissue regeneration and carcinogenesis, the Endothelial Growth Factor D Vascular (VEGFD), located in the Xp22.31 region, with expression in lung, heart, small intestine, uterus, breast, neuroblastoma and neural tissue, represents a strong candidate for molecular analysis as a cause of the syndrome.

PAGOD syndrome and vascular anomalies: is a defect embryonic angiogenesis? A case report and review.

PAGOD Syndrome is an acronym for lung and pulmonary arteries hypoplasia, agonadism, omphalocele / diaphragmatic defect and dextrocardia. A series of 21 patients is described, where 90.5% had a 46,XY karyotype and only two cases 46,XX; 66.6% exhibited a female phenotype and 28.6% ambiguous genitalia. The occurrence of two patients 46,XX excludes the Y chromosome as a carrier of the genetic defect and raises the possibility of a recessive X-linked inheritance, without ruling out that the observed cases in siblings may be due to mutations in other genes as Stra6, VEGFA, VEGFB, VEGFC, and alternative splicing of transcripts VEGFA, HIF1, HIF2, among others. Congenital malformations were observed in patients' genitals and gonads 85.7%, 66.6% in diaphragm and abdominal wall , heart 80.9%, 71.4% lungs, blood vessels 80.9% and 42.8% in abdomen. The review of patients has demonstrated a high degree of variability in the expression of malformations of organs and organ systems. Vascular malformations represent an important and characteristic component of PAGOD syndrome and whose base morphogenetic syndrome may be due to a defect in early embryonic angiogenesis with impact on organogenesis and system development. Among genes related to vascular remodeling during embryogenesis, tissue regeneration and carcinogenesis, the Endothelial Growth Factor D Vascular (VEGFD), located in the Xp22.31 region, with expression in lung, heart, small intestine, uterus, breast, neuroblastoma and neural tissue, represents a strong candidate for molecular analysis as a cause of the syndrome.

Petty-Laxova-Wiedemann progeroid syndrome: further phenotypical delineation and confirmation of a rare syndrome of premature aging.

A 10-year-old boy with manifestations of Petty-Laxova-Wiedemann progeroid syndrome (PLWPS), a rare neonatal progeroid condition, is described and compared with those previously reported. Clinical manifestation include: severe pre- and postnatal growth retardation, "progeroid" face, large open fontanelle in infancy, umbilical hernia at birth, pseudomacrocephaly, wide calvaria, sparse scalp hair, markedly diminished subcutaneous fat, scoliosis, partial cutaneous syndactyly, aplastic and hypoplastic distal phalanges with aplasia and hypoplasia of nails, undescended testes, and normal cognitive and motor development. This appears to be one of only a handful of cases of PLWPS reported in an older child or adult.

Human disorganization complex, as a polytopic blastogenesis defect: a new case.

We describe a baby girl of 4,000 g and 55 cm with supernumerary, malformed, and partially duplicated lower limbs, malformed and partially duplicated pelvis, spina bifida, coccygeal dermal sinus, ectopic anus located in the right buttock, duplicated internal genitalia, rectovaginal fistula, ileal atresia, Meckel diverticulum, and various renal system anomalies. We think that this phenotype is a new case of disorganization in humans (DsH) and postulate that this condition constitutes a polytopic defect of the blastogenesis. In this case, the presence of a malformation pattern involving structures in different parts of the body and organs derived from all of the germ layers, suggests that the pathogenetic event most probably occurred during blastogenesis affecting various progenitors fields.

Detección de portadoras de distrofia muscular Duchenne/Becker a través del análisis de loci STRs ligados al gen de la distrofina en familias venezolanas / Carrier Detection of muscular dystrophy Duchenne/Becker by analysis de STRs loci linked to the gene of the distrofina in venezuelan families

La Distrofia Muscular tipo Duchenne/Becker (DMD/DMB) es una enfermedad letal recesiva ligada al cromosoma X; el riesgo de recurrencia en una mujer portadora de DMD/DMB es de 50 por ciento de hijos sanos y 50 por ciento de hijos enfermos, 50 por ciento de hijas no portadoras y 50 por ciento de hijas portadoras, en cada gestación. El diagnóstico de DMD/DMB en una familia establece la necesidad de detectar a las mujeres portadoras con la finalidad de poder establecer el asesoramiento genético y el diagnóstico prenatal. El análisis de los polimorfismos de repeticiones cortas en tandem (STRs) localizados en los extremos 5, 3ïe intrones 44, 45, 49 y 50 del gen de la Distrofina se han utilizado para determinar los haplotipos en personas normales y en riesgo, a través de establecer el ligamiento genético entre el gen mutado y el haplotipo segregado. Se analizaron 105 individuos provenientes de 15 familias venezolanas con DMD/DMB, con uno o más afectados y 7 varones no emparentados. De los 105 individuos, 37 eran varones (26 afectados y 11 sanos) y 68 mujeres. Se amplificaron las secuencias STRs (STR44, STR45, STR49, STR 50 y STR3ïDYS) del gen de la distrofina por reacción en cadena de la polimerasa y se analizaron loa alelos polimórficos en los individuos estudiados. En 5/15 (33 por ciento) familias demostró la deleción de uno o varios exones. De las 68 mujeres, 27 (39,7 por ciento) resultaron portadoras, 27 (39,7 por ciento) no portadoras y en 14 (20,58 por ciento) no se pudo establecer un diagnóstico definitivo. En conclusión esta investigación pudo establecer el diagnóstico en 79,4 por ciento de las mujeres. Además en una familia se demostró que la mutación original ocurrió con el cromosoma X del abuelo materno, en otra se hizo el diagnóstico directo de portadora por hemicigosidad para el alelo mutado y en otra fue posible el diagnóstico prenatal. No se pudo excluir el mosaicismo germinal en 3 casos

Del(1)(q23) in a patient with Hutchinson-Gilford progeria.

A 9-year-old patient with the classical clinical picture of Hutchinson-Gilford progeria (HGP) is described. The karyotype shows a 46,XY,del(1)(q23) constitution. Our findings suggest that the interval 1q23 may play a roll in the etiology of HGP. A perturbation in glycosylation in connective tissue has been demonstrated in patients with this condition. This abnormality may be due to a defect in the UDP-galactose:beta-N-acetylglucosamina-beta-1,4-galactosyltransferase 3 (B4GALT3) gene that has been mapped in the interval 1q21-23. The cytogenetical analyses of this patient suggest that the B4GALT3 gene could be involved in the pathogenesis of HGP.

[Carrier detection of Duchenne/Becker muscular dystrophy by analysis of STRs loci linked to the gene of dystrophin in Venezuelan families]. / Detección de portadoras de distrofia muscular Duchenne/Becker a través del análisis de loci STRs ligados al gen de la distrofina en familias venezolanas.

The Duchenne/Becker Muscular Dystrophy (DMD/BMD) is an X linked recessive lethal disease. The female carrier will transmit the disease gene to half of her sons and half of her daughters; half of the daughters will be carriers, while half will be normal. Half of the sons will be normal and, on average, half will have the disease. It is of particular relevance to be able to detect carrier status among female relatives of the patients for genetic counseling and prenatal diagnosis. The method of Short Tandem Repeat (STR) sequence polymorphism analysis can determine haplotype at normal status or at risk status and, to establish genetic linkage between the mutated gene and the segregated haplotype. We have analyzed 105 members from 15 unrelated Venezuelan families with one or more siblings affected with DMD/DMB and 7 unrelated males. Of the 105, 37 were male (26 affected and 11 normal) and 68 were female. STR sequences (STR44, STR45, STR49, STR50, STR3'DYS) of the gene of the Dystrophin were amplified by polymerase chain reaction (PCR) to analyze allelic polymorphism in the families. Five of the 15 families (33%) had a deletion of one or several of the exons. Of the 68 females, 27 (39.7%) were carriers, 27 (39.7%) were non-carriers and in 14 cases (20.58%) it was not possible to reach a definitive diagnosis. The definitive diagnosis could be established in 79% of the females. This analysis also shows that the mutation occurred on the grandpaternal X chromosome in one family. Hemizygocity was detected and carrier status ascertained in the mother of other patient and in one family we were able to do prenatal diagnosis. The germinal mosaicism could not be excluded in 3 patients.

Hipoplasia de tibia, polidactilia y pulgar trifalángico: primera familia descrita en Venezuela / Hypoplasia of tibia polydactyly and triphalangeal thumbs: first family described in Venezuela

Werner en 1915, describió un paciente con las siguientes características: aplasia o hipoplasia bilateral de tibia, polidactilia y ausencia de pulgares. El modo de herencia es autosómico dominante, con expresividad variable. El objetivo de este trabajo es describir una niña en la que se demostró clínica y radiológicamente la presencia de signos compatibles con el diagnóstico de Hipoplasia de Tibia con Polidactilia. El estudio genealógico permite suponer que el gen tiene una expresividad variable, ya que por la línea materna se encontraron malformaciones tales como: sindactilia en manos, implantación proximal de pulgares y tibia vara. Se discuten los aspectos clínicos, radiológicos y genéticos

Síndrome de pfiffer asociado a cráneo en trébol: primer caso descrito en Venezuela / Pfeiffer s syndrome associated to cloverleaf skull: first case described in Venezuela

En 1964, Pfeiffer describió un síndrome que consiste en craneosinostosis, pulgares anchos, primer ortejo grande y sindactilia cutánea parcial de manos y pies, por lo que se incluyó en el grupo de los síndromes de acrocefalosindactilia. Se describe un lactante menor, masculino, producto de VII gesta, embarazo simple, a término, no controlado, sin complicaciones, madre y padre sanos, no consanguíneos, de 32 y 50 años, respectivamente; quien llena los criterios diagnóstiscos y pronósticos de Síndrome de Pfeiffer, subtipo 2. Se discuten los aspectos clínicos, radiológicos, tomográficos y genéticos