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Eur J Med Genet. 2014 Sep;57(9):503-9. doi: 10.1016/j.ejmg.2014.05.006. Epub 2014 May 27.

Severe ipsilateral musculoskeletal involvement in a Cornelia de Lange patient with a novel NIPBL mutation.

Author information

1
Unit of Clinical Genetics and Functional Genomics, Departments of Pharmacology- Physiology and Pediatrics, Medical School, University of Zaragoza, Spain; Department of Pediatrics, Hospital Pablo Tobón Uribe, Medellín, Colombia.
2
Unit of Clinical Genetics and Functional Genomics, Departments of Pharmacology- Physiology and Pediatrics, Medical School, University of Zaragoza, Spain.
3
Unit of Clinical Genetics and Functional Genomics, Departments of Pharmacology- Physiology and Pediatrics, Medical School, University of Zaragoza, Spain; Service of Pediatrics, Hospital Clínico Universitario "Lozano Blesa", Zaragoza, Spain.
4
Department of Molecular Biology, Sciences School, National University of Río Cuarto, Argentina.
5
Service of Pediatrics, Hospital Clínico Universitario "Lozano Blesa", Zaragoza, Spain.
6
Cell Cycle Group, Cancer Epigenetics and Biology Program (PEBC), Institut d'Investigacions Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
7
Quantitative Genomic Medicine Laboratories, Barcelona, Spain.
8
Molecular Modelling Group, Center of Molecular Biology ''Severo Ochoa'' (CSIC-UAM), Cantoblanco, Madrid, Spain.
9
Pediatric Clinic, University of Milano Bicocca, San Gerardo Hospital, Monza, Italy.
10
Unit of Clinical Genetics and Functional Genomics, Departments of Pharmacology- Physiology and Pediatrics, Medical School, University of Zaragoza, Spain. Electronic address: juanpie@unizar.es.

Abstract

Cornelia de Lange Syndrome (CdLS) is a congenital autosomal dominant (NIPBL, SMC3 and RAD21) or X-linked (SMC1A and HDAC8) disorder characterized by facial dysmorphism, pre and postnatal growth retardation, developmental delay and/or intellectual disability, and multiorgan involvement. Musculoskeletal malformations are usually bilateral and affect mainly the upper limbs; the range goes from brachyclinodactyly to severe reduction defects. Instead lower extremities are usually less and mildly involved. Here, we report on a 3-year-old Senegalese boy with typical craniofacial CdLS features, pre and postnatal growth retardation, atrial septal defect, developmental delay and right ipsilateral limb malformations, consistent with oligodactyly of the 3rd and 4th fingers, tibial agenesis and fibula hypoplasia. Exome sequencing and Sanger sequencing showed a novel missense mutation in NIPBL gene (c.6647A>G; p.(Tyr2216Cys)), which affects a conserved residue located within NIPBL HEAT repeat elements. Pyrosequencing analysis of NIPBL gene, disclosed similar levels of wild-type and mutated alleles in DNA and RNA samples from all tissues analyzed (oral mucosa epithelial cells, peripheral blood leukocytes and fibroblasts). These findings indicated the absence of somatic mosaicism, despite of the segmental asymmetry of the limbs, and confirmed biallelic expression for NIPBL transcripts, respectively. Additionally, conditions like Split-hand/foot malformation with long-bone deficiency secondary to duplication of BHLHA9 gene have been ruled out by the array-CGH and MLPA analysis. To our knowledge, this is the first CdLS patient described with major ipsilateral malformations of both the upper and lower extremities, that even though this finding could be due to a random event, expands the spectrum of limb reduction defects in CdLS.

KEYWORDS:

BHLHA9 duplication; CdLS; Cornelia de Lange Syndrome; Exome sequencing; HEAT repeat; Ipsilateral; Musculoskeletal involvement; NIPBL mutation

PMID:
24874887
DOI:
10.1016/j.ejmg.2014.05.006
[Indexed for MEDLINE]

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