Pathogenic variants in EP300 and ANKRD11 in patients with phenotypes overlapping Cornelia de Lange syndrome.

Cornelia de Lange syndrome (CdLS), Rubinstein-Taybi syndrome (RSTS), and KBG syndrome are three distinct developmental human disorders. Variants in seven genes belonging to the cohesin pathway, NIPBL, SMC1A, SMC3, HDAC8, RAD21, ANKRD11, and BRD4, were identified in about 80% of patients with CdLS, suggesting that additional causative genes remain to be discovered. Two genes, CREBBP and EP300, have been associated with RSTS, whereas KBG results from variants in ANKRD11. By exome sequencing, a genetic cause was elucidated in two patients with clinical diagnosis of CdLS but without variants in known CdLS genes. In particular, genetic variants in EP300 and ANKRD11 were identified in the two patients with CdLS. EP300 and ANKRD11 pathogenic variants caused the reduction of the respective proteins suggesting that their low levels contribute to CdLS-like phenotype. These findings highlight the clinical overlap between CdLS, RSTS, and KBG and support the notion that these rare disorders are linked to abnormal chromatin remodeling, which in turn affects the transcriptional machinery.

Expanding the phenotypic spectrum in EP300-related Rubinstein-Taybi syndrome.

Rubinstein-Taybi syndrome (RSTS) can be caused by heterozygous mutations or deletions involving CREBBP or, less commonly, EP300. To date, only 15 patients with EP300 mutations have been clinically described. Frequently reported manifestations in these patients include characteristic facial and limb features, varying degrees of neurocognitive dysfunction, and maternal preeclampsia. Other congenital anomalies are less frequently reported. We describe a child found to have a de novo EP300 mutation (c.4933C>T, predicted to result in p.Arg1645X) through research-based whole-genome sequencing of the family trio. The child's presentation involved dysmorphic features as well as unilateral renal agenesis, a myelomeningocele, and minor genitourinary anomalies. The involvement of congenital anomalies in all 16 clinically described patients with EP300 mutations (25% of which have been identified by "hypothesis free" methods, including microarray, exome, and whole-genome sequencing) is reviewed. In summary, genitourinary anomalies have been identified in 38%, cardiovascular anomalies in 25%, spinal/vertebral anomalies in 19%, other skeletal anomalies in 19%, brain anomalies in 13%, and renal anomalies in 6%. Our patient expands the phenotypic spectrum in EP300-related RSTS; this case demonstrates the evolving practice of clinical genomics related to increasing availability of genomic sequencing methods.

Keloids in Rubinstein-Taybi syndrome: a clinical study.

BACKGROUND: Rubinstein-Taybi syndrome (RSTS) is a multiple congenital anomalies-intellectual disability syndrome. One of the complications is keloid formation. Keloids are proliferative fibrous growths resulting from excessive tissue response to skin trauma. OBJECTIVES: To describe the clinical characteristics of keloids in individuals with RSTS reported in the literature and in a cohort of personally evaluated individuals with RSTS. PATIENTS AND METHODS: We performed a literature search for descriptions of RSTS individuals with keloids. All known individuals with RSTS in the Netherlands filled out three dedicated questionnaires. All individuals with (possible) keloids were personally evaluated. A further series of individuals with RSTS from the U.K. was personally evaluated. RESULTS: Reliable data were available for 62 of the 83 Dutch individuals with RSTS and showed 15 individuals with RSTS (24%) to have keloids. The 15 Dutch and 12 U.K. individuals with RSTS with keloids demonstrated that most patients have multiple keloids (n > 1: 82%; n > 5: 30%). Mean age of onset is 11·9 years. The majority of keloids are located on the shoulders and chest. The mean length × width of the largest keloid was 7·1 × 2·8 cm, and the mean thickness was 0·7 cm. All affected individuals complained of itching. Generally, treatment results were disappointing. CONCLUSIONS: Keloids occur in 24% of individuals with RSTS, either spontaneously or after a minor trauma, usually starting in early puberty. Management schedules have disappointing results. RSTS is a Mendelian disorder with a known molecular basis, and offers excellent opportunities to study the pathogenesis of keloids in general and to search for possible treatments.

Síndrome de Rubinstein-Taybi / The Rubistein-Taybi syndrome

Se presentan las características oftalmológicas y clínicas de una paciente que se concluyó con la presencia del síndrome de Rubinstein-Taybi. Este se incluye dentro de los síndromes genéticos y está basado en el fallo del cromosoma 16. La presentación es poco frecuente y no bien conocida, ya que posee características fundamentales que lo distinguen: dedos de los pies grandes y gruesos, pulgares anchos, exceso de pelo en el cuerpo (hirsutismo), microcefalia, boca estrecha, pequeña con dientes apiñados, nariz prominente o curva, cejas arqueadas y pobladas con pesta±as largas e inclinación palpebral de los ojos.

The ophthalmologic and clinical characteristics of a patient with Rubistein-Taybi syndrome were presented. This is considered one of the genetic syndromes and is based on chromosome 16 failure. The presentation of this syndrome is rather unusual and barely known since the fundamental characteristics that differentiate it are big thick toes, big thumbs, hirsutism, microcephaly, small narrow mouth full of packed teeth, prominent nose, raised and hairy eyebrows, long eyelash and palpebral inclination of eyes.

Síndrome de Rubinstein-Taybi / The Rubistein-Taybi syndrome

Se presentan las características oftalmológicas y clínicas de una paciente que se concluyó con la presencia del síndrome de Rubinstein-Taybi. Este se incluye dentro de los síndromes genéticos y está basado en el fallo del cromosoma 16. La presentación es poco frecuente y no bien conocida, ya que posee características fundamentales que lo distinguen: dedos de los pies grandes y gruesos, pulgares anchos, exceso de pelo en el cuerpo (hirsutismo), microcefalia, boca estrecha, pequeña con dientes apiñados, nariz prominente o curva, cejas arqueadas y pobladas con pesta±as largas e inclinación palpebral de los ojos(AU)

The ophthalmologic and clinical characteristics of a patient with Rubistein-Taybi syndrome were presented. This is considered one of the genetic syndromes and is based on chromosome 16 failure. The presentation of this syndrome is rather unusual and barely known since the fundamental characteristics that differentiate it are big thick toes, big thumbs, hirsutism, microcephaly, small narrow mouth full of packed teeth, prominent nose, raised and hairy eyebrows, long eyelash and palpebral inclination of eyes(AU)

Association of assisted reproductive technology with twinning and congenital anomalies.

Recently many reports have been published on the use of intracytoplasmic sperm injection (ICSI) and the increased risk of congenital major malformations or syndromes. We present three cases with Goldenhar syndrome (one of them a twin pair) and one case with Rubinstein-Taybi syndrome (RTS), also a twin pair. All four female cases are derived from ICSI. Goldenhar syndrome with ICSI pregnancy has been reported previously but as far as we know, RTS has not been described in association with assisted reproductive technology (ART). The four new cases reported herein will contribute to a better understanding whether ICSI pregnancy increases congenital malformations.

Rubinstein-Taybi syndrome.

In this review a short overview of pertinent clinical and molecular data of the Rubinstein-Taybi syndrome are provided. A diagnostic decision algorithm, and major issues that should be considered in the management of patients are discussed. Suggestions for further research are given.

Estenosis hipertrófica del píloro y cardiopatía congénita / Hypertrophic pyloric stenosis and congenital heart disease

Introducción. La prevalencia de las cardiopatías congénitas ronda el 10:1.000, y la de la estenosis hipertrófica del piloro el 3:1.000. El objetivo del estudio fue estimar la posible asociación de ambas anomalías.Método. El estudio es retrospectivo. Se revisó el fichero de las cardiopatías congénitas prestando atención al tipo de cardiopatía y a las malformaciones y síndromes asociados. Los controles fueron pacientes sin evidencia de cardiopatía.Resultados. Se observaron 12 casos de estenosis hipertrófica del píloro entre 3.693 niños sin cardiopatía, y 13 casos de estenosis hipertrófica del píloro entre 1.700 niños con cardiopatía congénita. 2/13 casos con estenosis hipertrófica del píloro y cardiopatía congénita fueron excluidos del estudio por haber recibido prostaglandinas; de los 11/13 restantes 7/11 estaban diagnosticados de comunicación interventricular, 1/11 de comunicación interauricular tipo ostium secundum, 1/11 de ductus, 1/11 de estenosis aórtica supravalvular, y 1/11 de enfermedad de Ebstein. La relación entre varones y mujeres fue de 0,87:1 para las comunicaciones interventriculares aislarlas y de 6:1 para las comunicaciones interventriculares con estenosis hipertrófica del píloro. La prevalencia de la estenosis hipertrófica del píloro entre los casos con cardiopatía congénita fue de 11/1.700 (odds ratio 2,00; intervalo de confianza al 95 por ciento 0,88 - 4,54, P 0.14), y entre los casos con comunicación interventricular fue de 7/445 (odds ratio 4,90; intervalo de confianza al 95 por ciento 1,91 - 12,55, P 0,0009).Conclusión. Es probable que exista una asociación entre la comunicación interventricular y la estenosis hipertrófica del píloro; se aconseja estar alerta a ambas anomalías cuando el clínico observe una de ellas (AU)

Etiology and recurrence risk in Rubinstein-Taybi syndrome.

Epidemiologic data on 45 patients with Rubinstein-Taybi syndrome from the Netherlands and 50 patients from the USA are compared with data from 407 patients reported in the literature. The 502 probands had a total of 708 sibs, including one probable recurrence. In 12 of 13 proven or possible monozygotic twins both children were affected. Two patients have reproduced with one affected and 2 normal offspring. The empiric recurrence risk figure for sibs is 0.1%. The recurrence risk for offspring of affected individuals could be as high as 50%. The cause of the syndrome remains unknown. There were no clues for autosomal recessive or X-linked inheritance, nor for a teratogenic cause. No consistent chromosome anomaly was found. An autosomal dominant mutation, either as submicroscopic chromosome deletion or duplication, or a point mutation seems the most likely explanation.

[Rubinstein-Taybi syndrome--a report of three cases].

The main features of Rubinstein-Taybi syndrome include special facial appearance, broad thumbs, great toes and mental retardation. This syndrome presents many organogenetic and systemic deformities and various congenital ocular abnormalities, such as epicanthus, antimogoloid palpebral fissures, highly arched eyebrows, long eyelashes, obstruction of nasolacrimal ducts, strabismus and iris coloboma. In this paper we report three children with Rubinstein-Taybi syndrome with the above systemic and ocular clinical findings, and think that the lacrimal abnormality should not be overlooked in this syndrome. We brief discuss the genetics of this syndrome and suggest that the search for minimal chromosomal defects by high resolution technique might be useful for etiologic and genetic research.

[A case of Rubinstein-Taybi syndrome]. / Przypadek zespolu Rubinsteina-Taybi.

The author reports a case of the Rubinstein-Taybi syndrome which has been described as yet in slightly more than 100 reports. In view of the ever increasing environmental pollution, particularly of industrial origin, genetic-ecological counselling poses ever new problems.