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.

Elevated second-trimester maternal serum ß-human chorionic gonadotropin and amniotic fluid alpha-fetoprotein as indicators of adverse obstetric outcomes in fetal Turner syndrome.

AIM: The objective of this study was to determine the ability of biochemical analytes to identify adverse outcomes in pregnancies with Turner syndrome. METHODS: Maternal serum and amniotic fluid (AF) marker concentrations were measured in 73 singleton pregnancies with Turner syndrome (10-22 weeks of gestation). Fetal Turner syndrome was definitively established by cytogenetic analysis. Two subgroups, fetuses with hydrops fetalis versus fetuses with cystic hygroma, were compared. Receiver operating characteristic curves and relative risk were established for a cut-off multiples of the median ≥3.5 for ß-subunit of human chorionic gonadotropin (hCG) or AF alpha-fetoprotein (AFP). RESULTS: Forty-nine (67%) of 73 pregnant women had an abnormal maternal serum. While levels of pregnancy-associated plasma protein-A and free ß-subunit (fß)-hCG were not different to those of the control group, AFP, unconjugated estriol and ß-hCG concentrations were significantly different in the study group (P < 0.05), when compared to those of unaffected pregnancies. Levels of ß-hCG in pregnancies with hydrops fetalis were significantly higher than in those with cystic hygroma (P <0.0001), as were AF-AFP concentrations (P <0.0015). In addition, abnormalities in both maternal serum ß-hCG and AF-AFP predicted fetal death. The relative risk of adverse obstetric outcome was 10.667 (P = 0.0004; 95% confidence interval [CI]: 1.554-73.203) for ß-hCG and 2.19 (P = 0.0256; 95% CI: 1.001 to 4.779), for AF-AFP. CONCLUSION: Maternal serum ß-hCG and AF-AFP levels may preferentially identify those Turner syndrome pregnancies with the highest risk of fetal death.

Polimorfismos intragénicos de los genes de los factores VIII y IX y su utilidad en el diagnóstico indirecto de portadoras de hemofilias A y B / Intragenic polymorphisms of factor VIII and IX genes and their utility in the indirect diagnosis of carriers of haemophilias A and B

Las Hemofilias A y B se consideran enfermedades hereditarias ligadas al sexo debidas a mutaciones en los genes que codifican para los factores VIII y IX respectivamente, ocasionando deficiencia en los niveles de la concentración plasmática de estas proteínas y cuyos roles son los de participar activamente en el mecanismo de la coagulación sanguínea. Se han reportado diversas mutaciones responsables de la alteración de estos genes; razón por la cual resulta poco práctico la aplicación de un método de diagnóstico molecular directo para la identificación de mujeres portadoras, por ello, una estrategia diagnóstica apropiada es el análisis indirecto de polimorfismos ligados al gen. El objetivo de este trabajo fue identificar mujeres portadoras en diversas familias con antecedentes de HA y HB residentes del estado Zulia, en Venezuela, caracterizando polimorfismos intragénicos de los genes del factor VIII y factor IX, los cuales permitieron asignar haplotipos y diagnosticar o descartar el estado portador al 95 por ciento de las mujeres que requerían el estudio para HA y al 100 por ciento para HB.

Haemophilia A and B are considered sex-linked inherited diseases caused by mutations in genes that encode factors VIII and IX, respectively. This results in the deficiency of these proteins plasma levels which are actively involved in the mechanism of blood coagulation. It has been reported that several mutations are responsible for the alteration of these genes, which is why the application of a molecular diagnostic method for the direct identification of female carriers is impractical. An appropriate diagnostic strategy is the indirect analysis of polymorphisms linked to the gene. The aim of this study was to identify female carriers in different families with history of HA and HB that live in Zulia State, Venezuela, characterizing intragenic gene polymorphisms of the clotting factors VIII and IX, which helped to identify and assign haplotypes, to diagnose or to exclude the carrying condition, to 95 percent of women who were needing the study for HA and to 100 percent for HB.

[Intragenic polymorphisms of factor VIII and IX genes and their utility in the indirect diagnosis of carriers of Haemophilias A and B]. / Polimorfismos intragénicos de los genes de los factores VIII y IX y su utilidad en el diagnóstico indirecto de portadoras de Hemofilias A y B.

Haemophilia A and B are considered sex-linked inherited diseases caused by mutations in genes that encode factors VIII and IX, respectively. This results in the deficiency of these proteins plasma levels which are actively involved in the mechanism of blood coagulation. It has been reported that several mutations are responsible for the alteration of these genes, which is why the application of a molecular diagnostic method for the direct identification of female carriers is impractical. An appropriate diagnostic strategy is the indirect analysis of polymorphisms linked to the gene. The aim of this study was to identify female carriers in different families with history of HA and HB that live in Zulia State, Venezuela, characterizing intragenic gene polymorphisms of the clotting factors VIII and IX, which helped to identify and assign haplotypes, to diagnose or to exclude the carrying condition, to 95% of women who were needing the study for HA and to 100% for HB.

[C677T polymorphism of the methylentetrahydrofolate reductase gene as risk factor in women with recurrent abortion]. / Polimorfismo C677T del gen de la Metiltetrahidrofolato Reductasa como factor de riesgo en mujeres con aborto recurrente.

The pathogenesis of recurrent spontaneous abortion is multifactorial, presumably involving the interaction of several genetic and environmental factors. The methylenetetrahydrofolate reductase (MTHFR) gene C677T polymorphism has been implicated as risk factor for recurrent spontaneous abortion (RA). The main objective of this research was to investigate the association between the C677T polymorphism of the MTHFR gene as a genetic risk factor for idiopathic RA. Molecular analysis was performed in 80 DNA samples from 30 patients with RA and among 50 healthy control subjects. Using the Polymerase Chain Reaction (PCR), a 198 bp (bases pairs) fragment, was digested with the restriction enzyme Hinf1, which can recognize the C > T substitution responsible for the polymorphism. 677T MTHFR allele frequencies for group with RA and the control group were 35% and 33%, respectively and 677C MTHFR allele frequencies were 65% and 67%, respectively. There was no significant difference in allele frequency between these two groups. The data presented in this study fail to support the relationship between MTHFR C677T polymorphism and risk in women with RA.

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.

Polimorfismo C677T del gen de la metiltetrahidrofolato reductasa como factor de riesgo en mujeres con aborto recurrente / C677T polymorphism of the methylentetrahydrofolate reductase gene as risk factor in women with recurrent abortion

La patogénesis de los abortos espontáneos recurrentes es multifactorial; probablemente se debe a la interacción de varios factores ambientales y genéticos. El polimorfismo C677T del gen de la metiltetrahidrofolato reductasa (MTHFR), ha sido implicado como factor de riesgo para aborto espontáneo recurrente (AR). El objetivo de este trabajo fue investigar la asociación del polimorfismo C677T de la MTHFR como factor de riesgo en AR idiopático. Se analizaron 80 muestras de ADN, correspondientes a 30 mujeres con AR y a 50 mujeres controles. A través de la reacción en cadena de la polimerasa (PCR) se amplificó un fragmento de 198 pares de base (pb), el cual se sometió a digestión con la enzima de restricción HinfI, que reconoce el sitio de restricción creado por la transición C>T en la posición 677. La frecuencia alélica de la MTHFR en el grupo de estudio y control fue 35% y 33% respectivamente; para el alelo T y 65% y 67% respectivamente, para el alelo C. No se encontró diferencia significativa entre el alelo T ni el C al ser comparados en ambos grupos. No se demostró un factor predisponente entre el polimorfismo C677T de la MTHFR y el AR en la muestra estudiada.

The pathogenesis of recurrent spontaneous abortion is multifactorial, presumably involving the interaction of several genetic and environmental factors. The methylenetetrahydrofolate reductase (MTHFR) gene C677T polymorphism has been implicated as risk factor for recurrent spontaneous abortion (RA). The main objective of this research was to investigate the association between the C677T polymorphism of the MTHFR gene as a genetic risk factor for idiopathic RA. Molecular analysis was performed in 80 DNA samples from 30 patients with RA and among 50 healthy control subjects. Using the Polymerase Chain Reaction (PCR), a 198 bp (bases pairs) fragment, was digested with the restriction enzyme HinfI, which can recognize the C > T substitution responsible for the polymorphism. 677T MTHFR allele frequencies for group with RA and the control group were 35% and 33%, respectively and 677C MTHFR allele frequencies were 65% and 67%, respectively. There was no significant difference in allele frequency between these two groups. The data presented in this study fail to support the relationship between MTHFR C677T polymorphism and risk in women with RA.

Defectos del tubo neural en productos de abortos espontáneos / Neural tube deffects in product of spontaneous abortions

Describir los defectos del tubo neural en productos menores de 20 semanas de gestación y destacar las implicaciones y utilidad de su diagnóstico en el asesoramiento a la pareja. Se realizó un estudio prospectivol, transeccional, descriptivo en una muestra no probabilística, constituida por productos de abortos espontáneos menores de 20 semanas de gestación. Se examinaron sistemáticamente las características morfológicas externas y los hallazgos anormales se registraron mediante descripción y fotografía. Laboratorio de Investigación “Dr. Carlos R. Davauchelle”, Cátedra de Histología y Embriología de la Universidad del Zulia, Maracaibo. De los 55 productos estudiados, 27 (49,09 por ciento) corresponden al sexo masculino, 21 (38,18 por ciento) al sexo femenino, y 7 (12,43 por ciento) cuyo sexo no pudo ser determinado de acuerdo a las características morfológicas de los genitales externos. Sólo 5 (9,09 por ciento) presentaron defectos del tubo neural y las anomalías encontradas fueron: anencefalia, craneorraquisquisis, espina bífida lumbosacra, iniencefalia y encefalocele. La identificación de los defectos del tubo neural en la muestra estudiada sirve como punto de partida para ofrecer asesoramiento médico a los padres acerca del riesgo de recurrencia, la utilización de medidas de prevención, el plan de acción a seguir ante futuros embarazos y la posibilidad de ofrecer el diagnóstico prenatal.

[Indirect prenatal molecular diagnostic of haemophilia A and B]. / Diagnóstico prenatal molecular indirecto de Hemofilia A y B.

Haemophilia A (HA) and B (HB) are the most common inherited bleeding diseases. HA and HB are X-linked recessive disorders caused by mutation in the factor VIII gene which maps to Xq28 and factor IX located at Xq27, respectively; resulting in absence or deficiency of these proteins. Several mutations have been reported as responsible for the disturbance of these genes; therefore, the use of direct molecular techniques to analyze the carrier status of women and their affected fetuses in not easy to perform. Thus, gene linked polymorphisms analysis is the most convenient molecular test since it is independent from the nature of the mutation, allowing the identification of the mutant X chromosome by following its segregation along the pedigree. The main objective of this research was to perform the molecular diagnosis of HA or HB carrier status in pregnant women and male fetuses affected or not, who were referred to the Medical Genetic Unit of the University of Zulia (UGM-LUZ), Maracaibo, Venezuela. Molecular analysis for HA and HB was performed in 32 DNA samples from 8 pregnant women, 8 fetuses, 8 affected and 8 healthy males. Using the Polymerase Chain Reaction (PCR), a 142 bp (bases pairs) fragment, which corresponds to intron 18 of the Factor VIII gene, was amplified. This fragment has a restriction polymorphism for the enzyme Bcl I. Additionally, a Duplex PCR was performed for the STRs (short tandem repeat) of introns 13 and 22 of the same gene. On the other hand, Hinf I, Xmn I y Taq I polymorphism in the factor IX gene were also amplified, so, we were able to build the haplotypes for each one of the key members in the families affected. The latter, allowed us to identify, in five of the eight cases, the mutant X chromosome responsible of HA and HB, thus, prenatal diagnosis was possible with the following results: three healthy males fetuses, two affected males fetuses with HA and three females fetuses.

Prospective prenatal serum screening for Down syndrome in Venezuela.

OBJECTIVE: To assess the usefulness of triple-marker screening for Down syndrome in Venezuela. METHOD: Maternal serum concentrations of alpha fetoprotein (AFP), beta human chorionic gonadotropin (beta-hCG), and unconjugated estriol (uE3) were measured weekly in 3895 women from the 15th to the 20th week of pregnancy. Population-specific likelihood ratios were determined and used to calculate the risk of fetal Down syndrome for each pregnancy. RESULTS: The median multiple of the median values for AFP, beta-hCG, and uE3 concentrations were 0.69, 2.10, and 0.67 for the affected pregnancies. The likelihood ratio for a positive result was 1:19. The detection and false-positive rates were 69.23% and 5.8%. CONCLUSION: These findings were consistent with reported data and therefore confirmed triple-marker serum screening as effective and suitable for prenatal care in Venezuela. Latin American governments and Health Agencies should recommend offering this screening method to all pregnant women.

Diagnóstico prenatal molecular indirecto de hemofilia A y B / Indirect prenatal molecular diagnostic of haemophilia A and B

La hemofilia A (HA) y B (HB), son enfermedades hereditarias de la coagulación sanguínea, su mecanismo de transmisión es recesivo ligado al cromosoma X y son debidas a mutaciones en los genes que codifican respectivamente para el factor VIII, localizado en Xq28 y para el factor IX, localizado en Xq27; esto ocasiona deficiencia o ausencia de estas proteínas en el plasma. Múltiples mutaciones son responsables de la alteración en estos dos genes, razón por la cual resulta poco práctica la aplicación de un método de diagnóstico molecular directo en la identificación de mujeres portadoras y de fetos afectados; por ello, la estrategia diagnóstica adecuada es el empleo de polimorfismos ligados al gen, los cuales son independientes de la mutación y su análisis permite seguirle la pista al cromosoma X portador de la mutación, apoyándose en el estudio del árbol genealógico familiar. El objetivo de este trabajo fue identificar desde el punto de vista molecular, gestantes portadoras de HA o HB y fetos varones afectados o no por estas enfermedades, referidos a la Unidad de Genética Médica de la Universidad del Zulia (UGM-LUZ), Maracaibo, Venezuela. Se analizaron 32 muestras de DNA correspondientes a 8 gestantes, 8 fetos, 8 varones afectados y 8 varones sanos para el factor VIII. A través de la reacción en cadena de la polimerasa (PCR), se amplificó un fragmento de 142 pares de bases (pb) que corresponde al intrón 18 del gen, el cual contiene un polimorfismo de restricción para la enzima BclI y a través de PCR duplex se amplificaron secuencias STRs de los intrones 13 y 22, y para el factor IX, se amplificaron los polimorfismos HinfI, XmnI y TaqI; se pudieron elaborar los haplotipos respectivos en las personas clave de las familias afectadas, que permitieron identificar en 5 de las 8 familias al cromosoma X portador de la mutación responsable de estas enfermedades, logrando diagnosticar tres fetos varones sanos, dos fetos varones afectados con HA y tres fetos hembras.

[Association of the vitamin D receptor gene BBAAtt haplotype with osteoporosis in post-menopausic women]. / Asociación del haplotipo BBAAtt del gen del receptor de la vitamina D con la osteoporosis en mujeres posmenopáusicas.

Osteoporosis (OP) is an important public issue affecting more than 150 millions all over the world, mainly post-menopausic women. Epidemiological studies have shown that the genetic factors could be involved in 80-90% of the bone mineral density variabiblity and therefore, related to the risk of OP manifestations. The vitamin D receptor (VRD) gene has been extensively studied, but its relationship with OP has been controversial. The aim of this investigation was to study the association of Bsm I, Apa I and Taq I VDR gene polymorphism with OP in 147 post-menopausic women; 71 with OP and 76 without the disease (control). The molecular gene analysis was performed using the polymerase chain reaction (PCR). The genotypes BB, AA, and tt were found in 56.33, 50.70 and 25.35% and in 21.05, 28.95 and 10.53% of OP patients and controls respectively. The haplotype BBAAtt was observed in 23.94% of OP patients and 5.26% of the controls. This haplotype was a risk factor for OP, since a odds ratio (OR) of 5.66 was found, while, haplotype BbaaTT was a protection factor (OR: 0.10). These findings support the association of the vitamin D receptor gene BBAAtt haplotype with OP.

Asociación del haplotipo BBAAtt del gen del receptor de la vitamina D con la osteoporosis en mujeres posmenopáusicas / Association of the vitamin D receptor gene BBAAtt haplotype with osteoporosis in post-menopausic women

La Osteoporosis (OP) es un problema de salud pública, que afecta a más de 150 millones de personas en el mundo, mayoritariamente mujeres posmenopáusicas. Estudios epidemiológicos demuestran que los factores genéticos podrían representar el 80-90 por ciento de la variabilidad en la densidad mineral ósea y en consecuencia relacionarse con el riesgo a sufrir OP. El gen del receptor de la vitamina D (RVD) se ha estudiado ampliamente en este campo y su relación con la osteoporosis ha sido controversial. El objetivo de esta investigación fue estudiar la asociación de los polimorfismos Bsm I, Apa I y Taq I del gen del RVD con la OP en 147 mujeres posmenopáusicas, 71 con OP y 76 sin la enfermedad (control). El análisis molecular se realizó utilizando la reacción en cadena de la polimerasa (RCP). Los genotipos BB, AA y tt se encontraron en 56,33, 50,70 y 25,35 por ciento y en 21,05, 28,95 y 10,53 por ciento, en el grupo con OP y control, respectivamente. El haplotipo BBAAtt se observó en un 23,94 por ciento en el grupo con OP y en 5,26 por ciento en el grupo control. Este haplotipo resultó ser factor de riesgo para la OP con Razón de disparidad (RD) de 5,66, mientras que el haplotipo BbaaTT, factor de protección (RD: 0,10). Estos hallazgos apoyan la asociación del haplotipo BBAAtt del gen del receptor de la vitamina D con la OP.

[Frequency of delta F508 mutation in Venezuelan patients with cystic fibrosis]. / Frecuencia de la mutación delta F508 en pacientes venezolanos afectados con fibrosis quística.

Cystic Fibrosis (CF) is the most common and severe autosomal recessive disease in Caucasian populations, with an incidence of 1 in 2500 live births. It is characterized by a generalized disturbance in exocrine glands and it is caused by over one thousand mutations at the cystic fibrosis conductance regulator gene (CFTR) mapped at 7q31. AF508 is the most frequent mutation worldwide and it consists in a deletion of the codon that encodes fenilalanine at the 508 protein's position. The aim of this study was to determine the frequency of the delta F508 mutation in Venezuelan patients with CF using the Polymerase Chain Reaction (PCR). We studied thirty patients of twenty eight families who were diagnosed with CF based on their clinical features and sweat chloride level > 60 mEq/l in two determinations. Detection of the mutation was performed from the amplification of a 98 pair of bases (pb) CF gene segment which contains the codon that encodes fenilalanine in the 508 position by PCR. This PCR product is absent in those who have the mutation. The delta F508 allelic frequency was 26.79%, distributed in six homozygous and seven compound heterozygote delta F508/X. The reminder mutations (no delta F508) represent 73.21%. The delta F508 frequency in our sample is less than the reported in European countries. On the other hand, a delta F508 frequency highly heterogeneous has been observed in Latin-American countries. This variation results from mixed populations with a different genetic background influenced by external migration and CF molecular alterations, which exists in the analyzed populations. In this study, the delta F508 mutation comes mainly from grandparents (79.41%) who were born in Mediterranean countries and Colombia, while the no delta F508 mutations come from grandparents who were born in Venezuela (79.27%) and Colombia (17.07%).

Frecuencia de la mutación F508 en pacientes venezolanos afectados con fibrosis quística / Frecuency of F508 mutation in venezuelan patients with cystic fibrosis

La fibrosis quística (FQ), es la enfermedad autosómica recesiva severa más frecuente en poblaciones caucásicas, en las que tiene una inicidencia de 1/2500 individuos. Se caracteriza por una alteración generalizada de las glándulas exocrinas y es producida por más de mil mutaciones de un gen localizado en la región 7q31, que codifica una proteína llamada regulador de la conductancia transmembrana de FQ (RCTFQ). La mutación más frecuente es la F508, que consiste en la deleción del codón que codifica a la fenilalanina en la posición 508. El objetivo de este trabajo fue determinar la frecuencia de la mutación F508 en pacientes venezolanos afectados con FQ mediante la reacción en cadena de la polimerasa (RCP). Se estudiaron 30 pacientes pertenecientes a 28 familias, que por clínica y 2 determinaciones de cloruros en sudor > 60 meq/L fueron diagnósticados como afectados con FQ. La detección de la mutación se realizó a partir de amplificación por RCP de un segmento del gen de FQ de 98 pares de bases (pb) que contiene el codón que codifica a la fenilalanina en la posición 508 y el cual está ausente en los que tienen la mutación. La frecuencia del alelo F508 fue de 26,79 por ciento, distribuídos en 6 hemocigotos F508 y 7 heterocigotos compuestos F508/X. El resto de las mutaciones, no F508, representaron el 73,21 por ciento. La frecuencia del alelo F508 en esta muestra es menor a la reportada en países europeos. En América Latina se ha observado una gran heterogeneidad en su frecuencia, esta variación podría explicarse por los diferentes patrones de mestizaje dados por migración externa y de las alteraciones moleculares de FQ que existen en la población que analice. En este trabajo, la mutación F508 proviene de abuelos en su mayoría (79,41 por ciento) nacidos en países mediterráneos y en Colombia y en las no F508, los abuelos son nacidos preferentemente en Venezuela (79,27 por ciento) y Colombia (17,07 por ciento)

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.