Next generation sequencing panel target genes: possible diagnostic tool for ectodermal dysplasia related diseases.

BACKGROUND: Ectodermal dysplasias (EDs) are a large and complex group of disorders affecting the ectoderm-derived organs; the clinical and genetic heterogeneity of these conditions renders an accurate diagnosis more challenging. The aim of this study is to demonstrate the clinical utility of a targeted resequencing panel through enhancing the molecular and clinical diagnosis of EDs. Given the recent developments in gene and protein-based therapies for X-linked hypohidrotic ectodermal dysplasia, there is a re-emerging interest in identifying the genetic basis of EDs and the respective phenotypic presentations, in an aim to facilitate potential treatments for affected families. METHODS: We assessed seventeen individuals, from three unrelated families, who presented with diverse phenotypes suggestive of ED. An extensive multidisciplinary clinical evaluation was performed followed by a targeted exome resequencing panel (including genes that are known to cause EDs). MiSeqTM data software was used, variants with Qscore >30 were accepted. RESULTS: Three different previously reported hemizygous EDA mutations were found in the families. However, a complete genotype-phenotype correlation could not be established, neither in our patients nor in the previously reported patients. CONCLUSIONS: Targeted exome resequencing can provide a rapid and accurate diagnosis of EDs, while further contributing to the existing ED genetic data. Moreover, the identification of the disease-causing mutation in an affected family is crucial for proper genetic counseling and the establishment of a genotype-phenotype correlation which will subsequently provide the affected individuals with a more suitable treatment plan.

Ectodysplasin pathogenic variants affecting the furin-cleavage site and unusual clinical features define X-linked hypohidrotic ectodermal dysplasia in India.

Hypohidrotic ectodermal dysplasia (HED) is a rare genetic disorder caused by mutational inactivation of a developmental pathway responsible for generation of tissues of ectodermal origin. The X-linked form accounts for the majority of HED cases and is caused by Ectodysplasin (EDA) pathogenic variants. We performed a combined analysis of 29 X-linked hypohidrotic ectodermal dysplasia (XLHED) families (including 12 from our previous studies). In addition to the classical triad of symptoms including loss (or reduction) of ectodermal structures, such as hair, teeth, and sweat glands, we detected additional HED-related clinical features including facial dysmorphism and hyperpigmentation in several patients. Interestingly, global developmental delay was identified as an unusual clinical symptom in many patients. More importantly, we identified 22 causal pathogenic variants that included 15 missense, four small in-dels, and one nonsense, splice site, and large deletion each. Interestingly, we detected 12 unique (India-specific) pathogenic variants. Of the 29 XLHED families analyzed, 11 (38%) harbored pathogenic variant localized to the furin cleavage site. A comparison with HGMD revealed significant differences in the frequency of missense pathogenic variants; involvement of specific exons and/or protein domains and transition/transversion ratios. A significantly higher proportion of missense pathogenic variants (33%) localized to the EDA furin cleavage when compared to HGMD (7%), of which p.R155C, p.R156C, and p.R156H were detected in three families each. Therefore, the first comprehensive analysis of XLHED from India has revealed several unique features including unusual clinical symptoms and high frequency of furin cleavage site pathogenic variants.

Síndrome de Haberland con afectación ocular bilateral / Haberland syndrome with bilateral ocular involvement

El síndrome de Haberland o lipomatosis encefalocraneocutánea es un síndrome muy infrecuente caracterizado por la tríada clásica de afectación cutánea, ocular y del sistema nervioso central. Fue descrito por primera vez en 1970 por Haberland y Perou, habiéndose descrito unos 60 casos desde entonces. Presentamos un caso de un varón de 14 semanas diagnosticado de síndrome de Haberland con afectación ocular bilateral en forma de coloboma palpebral y coristomas

Haberland syndrome or encephalocutaneous lipomatosis is a very uncommon syndrome that is characterised by changes in the skin, eye, and central nervous system. It was first described in 1970 by Haberland and Perou, with about 60 cases having been reported since then. A case is reported of a 14-week-old male diagnosed with Haberland syndrome with bilateral ocular involvement in the form of palpebral coloboma and choristomas

La vulneración de la autodeterminación informativa de los pacientes en patología genética. A propósito de la sentencia del Tribunal Superior de Justicia de Galicia de 10 de julio de 2019 / The vulneration of the patients informative self-determination in genetic pathology with regard to the decision of the Galicia High Court of Justice of 10 July 2019

En el presente trabajo abordaremos la sentencia del Tribunal Superior de Justicia de Galicia de 10 de julio de 2019. Se trata de un caso en el que se cuestionan los daños derivados de la ausencia de una genuina labor de consejo genético, en una paciente con una patología hereditaria. En nuestro comentario trataremos los argumentos de las partes, así como una aproximación crítica al análisis del Tribunal, y al uso generalizado de la institución jurídica de la "pérdida de oportunidad" como fundamento de la responsabilidad patrimonial de la Administración

In this paper, we will address the resolution of the Galician Superior Court, 10th July 2019. It deals with the damages coming from the lack of true genetic counselling, concerning a patient with a hereditary genetic disorder. In this piece, we will focus on the parties' arguments, and also with a critic approach to the Court analysis, regarding the general utilisation of the legal institution "loss of therapeutic chance" as a founding basis of the Administration liability

Prenatal Treatment of X-Linked Hypohidrotic Ectodermal Dysplasia using Recombinant Ectodysplasin in a Canine Model.

X-linked hypohidrotic ectodermal dysplasia (XLHED) is caused by defects in the EDA gene that inactivate the function of ectodysplasin A1 (EDA1). This leads to abnormal development of eccrine glands, hair follicles, and teeth, and to frequent respiratory infections. Previous studies in the naturally occurring dog model demonstrated partial prevention of the XLHED phenotype by postnatal administration of recombinant EDA1. The results suggested that a single or two temporally spaced injections of EDI200 prenatally might improve the clinical outcome in the dog model. Fetuses received ultrasound-guided EDI200 intra-amniotically at gestational days 32 and 45, or 45 or 55 alone (of a 65-day pregnancy). Growth rates, lacrimation, hair growth, meibomian glands, sweating, dentition, and mucociliary clearance were compared in treated and untreated XLHED-affected dogs, and in heterozygous and wild-type control dogs. Improved phenotypic outcomes were noted in the earlier and more frequently treated animals. All animals treated prenatally showed positive responses compared with untreated dogs with XLHED, most notably in the transfer of moisture through paw pads, suggesting improved onset of sweating ability and restored meibomian gland development. These results exemplify the feasibility of ultrasound-guided intra-amniotic injections for the treatment of developmental disorders, with improved formation of specific EDA1-dependent structures in dogs with XLHED.

Hypohydrotic Ectodermal Dysplasia in an Indian Family.

Hereditary ectodermal dysplasia (HED) is a rare genetic disorder chiefly affecting ectodermally derived structures including hair, nails, sweat glands etc. with pathognomic manifestations such as hypotrichosis, hypohidrosis, and hypodontia. Hypohidrotic ectodermal dysplaisa, being the most frequently encountered subtype and HED, being the rare subtype. HED is primarily transmitted through X-linked recessive trait in which the gene is carried by the female and manifested in male. Although rare, this disorder may be seen affecting lot of members of the same family. We hereby report a series of four cases with common classical manifestations accompanied with spoon shaped nails, hyperpigmentation, oligodontia and hypotrichosis. The patients were treated for prosthetic rehabilitation and were asked to wear cool clothing.

Variants of the ectodysplasin A1 receptor gene underlying homozygous cases of autosomal recessive hypohidrotic ectodermal dysplasia.

Hypohidrotic ectodermal dysplasia (HED) is a rare genetic condition resulting from defective development of ectodermal derivatives, such as hair, teeth, and sweat glands. Autosomal recessive (AR) forms of HED may be caused by pathogenic variants of the ectodysplasin A1 receptor (EDAR) gene that encodes a receptor involved in the NF-κB signaling pathway. Here, we describe three cases of AR-HED in families of Turkish, Austrian, and German-American origin (with or without known consanguinity). In these cases, two out-of-frame deletions and a pathogenic missense variant of EDAR were found to be disease-causing due to reduced availability of the respective messenger RNA or impaired interaction of the encoded protein with its binding partner leading to diminished signal transduction. The same missense variant, c.1258C>T (p.Arg420Trp), has actually been reported to be restricted to the Icelandic population and to be associated with non-syndromic tooth agenesis but not HED. As our patient has no known relationship to Icelandic individuals and displays a rather severe HED phenotype, we suggest that EDAR-Arg420Trp is a more widespread variant, possibly with variable clinical expressivity.

Hypohidrotic Ectodermal Dysplasia: A Rare Disorder With Bilateral Infantile Glaucoma.

Ectodermal dysplasia (ED) is a disorder that occurs due to abnormalities of ectodermal structures such as skin, teeth, hair, nails, and eccrine glands. Approximately 200 different conditions have been identified as ED, the most common being hypohidrotic ED. It is characterized by hypotrichosis (sparse scalp or body hair), hypodontia (absent or malformed teeth), and hypohidrosis (reduced ability to sweat). It is also associated with distinctive facial features, such as the prominent forehead, thick lips, flattened nasal bridge, and thin wrinkled skin. Ocular anomalies are less frequently observed, the most common ones being dysplasia of the lacrimal gland or meibomian gland that leads to dry eye and variable corneal involvement. We report a case of a 9-year-old child of hypohidrotic ED presenting with bilateral infantile glaucoma managed by the implantation of glaucoma drainage devices (GDDs) after a failed trabeculotomy and trabeculectomy in both eyes.

Conservation analysis and pathogenicity prediction of mutant genes of ectodysplasin a.

BACKGROUND: Hypohidrotic ectodermal dysplasia (HED) is a common recessive X-linked hereditary disease that affects the development of ectoderm. Gene mutations of ectodysplasin A (EDA) play key roles in process of this disease. In our preliminary study, three unknown mutation sites (c.878 T > G, c.663-697del and c.587-615del) were detected from the pedigrees of HED. METHODS: Conservation analysis of the related homologous proteins in 3 unknown EDA gene mutation sites was conducted using the University of California Santa Cruz (UCSC) Genome Browser database. SIFT and PolyPhen-2, the online gene function prediction software, were utilized to predict the pathogenicity of point mutation of c.878 T > G. RESULTS: All three unknown mutation sites were located in the highly-conserved region of EDA and possessed strong amino acid conservation among different species. In addition, the results of the pathogenicity prediction of point mutation of c.878 T > G by SIFT (P = 0.00) and PolyPhen-2 (S = 0.997) demonstrated that the mutation site had considerable pathogenicity theoretically. CONCLUSIONS: The EDA mutations of c.878 T > G, c.663-697del and c.587-615del may be responsible for the pathogenesis of HED in their pedigrees.

Displasia ectodérmica hipohidrótica: reporte de casos / Hypohydrotic ectodermal dysplasia: Report of case

La Displasia Ectodérmica Hipohidrótica (DEH) es una genodermatosis que se caracteriza por presentar alteraciones en las estructuras deri-vadas del ectodermo, frecuentemente se da la triada: hipohidrosis, hipotricosis e hipodoncia. El síndrome puede manifestarse como heren-cia autosómica dominante o recesiva y tam-bién como herencia ligada al sexo, la forma más frecuente es la de herencia recesiva relacionada al cromosoma X con sujetos de sexo masculino afectados y de sexo femenino portadores. Puede ocurrir a través de mutacio-nes autosómicas, de las cuales las del gen EDA1 son responsables del 58% de los casos. La DEH presenta tasa de mortalidad infantil entre 2% y 20%, dependiendo de la precocidad del diag-nóstico y de los protocolos de tratamiento. Este artículo presenta un paciente de 23 meses de edad quien había sido hospitalizado por otra-patología y se re rió al Instituto Hondureño de Seguridad Social (IHSS), por observar cabello hipopigmentado, escaso, no, ausencia de pestañas y cejas, dientes cónicos e hipohidro-sis: por lo que se diagnostica displasia ectodér-mica hipohidrótica, quedando pendiente la realización de biopsia de piel y exámenes genéticos debido a que no se cuenta con el equipo médico necesario. Por tal motivo, no se conoció el patrón de segregación...(AU)

Múltiples malformaciones vasculares en un paciente con enanismo primordial osteodisplásico microcefálico tipo II / Multiple vascular malformations in a patient with microcephalic osteodysplastic primordial dwarfism type II

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Displasia ectodérmica hipohidróticaa en dos hermanas / Hypohidrotic ectodermal dysplasia in two sisters

La displasia ectodérmica hipohidrótica es un síndrome congénito, caracterizado por la tríada hipohidrosis, hipotricosis e hipodoncia no progresivas. La forma más común es lade herencia recesiva ligada al cromosoma X, aunque también existe una autosómica recesiva y otra dominante. Su tratamiento incluye un manejo interdisciplinario, con medidas de soporte para las manifestaciones clínicas del trastorno y el asesoramiento genético familiar.

Hypohidrotic ectodermal dysplasia is a congenital syndrome characterized by the triad of hypohidrosis, hypotrichosis and non-progressivehypodontia. The most common form is the one inherited in a recessive X-linked way, although there is also an autosomal recessive and a dominant ones. Treatment includes the interdisciplinary management, supportive for the clinical manifestations of the disorder and family genetic counseling.

A novel mutation in the EDAR gene causes severe autosomal recessive hypohidrotic ectodermal dysplasia.

We report on a 2-year-old girl presenting with a severe form of hypohidrotic ectodermal dysplasia (HED). The patient presented with hypotrichosis, anodontia, hypohidrosis, frontal bossing, prominent lips and ears, dry, pale skin, and dermatitis. The patient had chronic rhinitis with malodorous nasal discharge. The girl was the second born child of first-cousin immigrants from Northern Iraq. A novel homozygous mutation (c.84delC) in the EDAR gene was identified. This mutation most likely causes a frameshift in the protein product (p.S29fs*74). This results in abolition of all ectodysplasin-mediated NF-kB signalling. This complete loss-of-function mutation likely accounts for the severe clinical abnormalities in ectodermal structures in the described patient.

Early respiratory and ocular involvement in X-linked hypohidrotic ectodermal dysplasia.

UNLABELLED: X-linked hypohidrotic ectodermal dysplasia (XLHED; ectodysplasin deficiency) has been classically described as affecting hair, sweat glands, and dentition. What may be underappreciated is the effect ectodysplasin deficiency has on glands surrounding the airways and eyes and the resulting chronic health issues. In this study, 12 male children (age range 6-13 years) and 14 male adults with XLHED (18-58 years of age) were investigated by pulmonary function tests, measurement of fractional exhaled nitric oxide, and by ophthalmologic assessments. Twelve healthy individuals (six children, six adults) served as controls. Signs of airway constriction and inflammation were detected in eight children with XLHED, including the youngest subject, and in ten adult XLHED patients. Increased tear osmolarity, reduced tear film break-up time, and other ocular abnormalities were also present at an early age. Five of 12 XLHED subjects not reporting a history of asthma and 7 of the 12 patients not reporting a history of dry eye issues showed at least two abnormal test results in the respective organ system. The presence of residual sweat ducts, suggestive of partial ectodysplasin gene expression, correlated with milder disease in two XLHED subjects with mutations affecting the collagen-like domain of ectodysplasin. CONCLUSION: The high prevalence of asthma-like symptoms in XLHED patients as young as 6 years and a similar prevalence of dry eye problems indicate that screening evaluation, regular monitoring, and consideration of therapeutic intervention should begin in early childhood.

Displasia ectodérmica hipohidrótica: Reporte de casos / Hypohydrotic ectodermal dysplasia: Report of cases

La Displasia Ectodérmica Hipohidrótica (DEH) es una genodermatosis que se caracteriza por presentar alteraciones en las estructuras derivadas del ectodermo y frecuentemente se da la triada: hipohidrosis, hipotricosis e hipodoncia. El síndrome puede manifestarse como herencia autosómica dominante o recesiva y también como herencia ligada al sexo. El objetivo de este artículo es presentar 6 casos clínicos atendidos en la clínica del Niño de la Facultad de odontología de la Universidad de Antioquia, entre 1998 y 2011. Se muestran las características faciales y dentales de una familia con displasia ectodérmica hipohidrótica con herencia ligada al cromosoma X. Para el tratamiento de este síndrome se propone un protocolo de manejo en forma integral y multidisciplinario (AU)

Ectodermal Hypohidrotic Dysplasia (EHD) is a genodermatosis characterized by the presence of the ectoderm-derived structures alterations and often the triad is given: Hypohidrosis, Hypotrichosis and hypodontia. The purpose of this article is to present 6 clinic cases attended in the Clinic of the Children Dental Care of the Faculty of dentistry of the University of Antioquia between 1998 and 2011. It´s document the oral and facial characteristics in this pathology in a family with inheritance associated with the X chromosome. For the treatment of this syndrome a protocol of management in multidisciplinary and integral form is proposed (AU)

Functional studies for the TRAF6 mutation associated with hypohidrotic ectodermal dysplasia.

BACKGROUND: Hypohidrotic ectodermal dysplasia (HED) is a rare condition characterized by hypotrichosis, hypohidrosis and hypodontia. A de novo heterozygous mutation in the tumour necrosis factor receptor-associated factor 6 gene (TRAF6) was recently identified in a patient with HED, while functional consequences resulting from the mutation remained unknown. OBJECTIVES: To determine the mechanism by which the TRAF6 mutation results in HED. METHODS: We performed coimmunoprecipitation (co-IP) studies to determine whether the mutation would affect the interaction of TRAF6 with transforming growth factor ß-activated kinase 1 (TAK1), TAK1-binding protein 2 (TAB 2) and ectodysplasin-A receptor-associated death domain protein (EDARADD). We then performed co-IP and glutathione S-transferase-pulldown assays to determine the TRAF6 binding sequences in EDARADD. In addition, we analysed the effect of the mutant TRAF6 protein on the affinity between wild-type TRAF6 and EDARADD, as well as on EDARADD-mediated nuclear factor (NF)-κB activation. RESULTS: The mutant TRAF6 protein was capable of forming a complex with TAK1 and TAB 2 in a similar way to wild-type TRAF6. However, the mutant TRAF6 protein completely lost the affinity to EDARADD, while the wild-type TRAF6 bound to the N-terminal domain of EDARADD. Furthermore, the mutant TRAF6 inhibited the interaction between the wild-type TRAF6 and EDARADD, and also potentially reduced the EDARADD-mediated NF-κB activity. CONCLUSIONS: We conclude that the mutant TRAF6 protein shows a dominant negative effect against the wild-type TRAF6 protein, which is predicted to affect the EDARADD-mediated activation of NF-κB during the development of ectoderm-derived organs, and to lead to the HED phenotype.

Elliptical Fourier descriptors for contours in three dimensions: a new tool for morphometrical analysis in biology.

Elliptical Fourier descriptor analysis is a method for the morphometric study of curves. It has been used in the two-dimensional plane for closed contours, but rarely for lines in the three-dimensional space. The method consists of an expansion of a contour as a sum of ellipses. In this article, we study three-dimensional contours, i.e. lines embedded in the three-dimensional space. We compute for the first time the relations between the Fourier coefficients and its geometric parameters. We then use these relations for normalization and reorientation of three-dimensional contours. Such an algorithm can be used to perform inter-individual comparisons between contours, regardless of differences in viewpoint or global size. Human and small animal illustrative examples using biomedical X-ray CT imaging data of open bone structures demonstrate the interest and potential of the method for morphological analysis.