Pallister-Hall syndrome associated with an unbalanced chromosome translocation

We report 3 cases of Pallister-Hall syndrome involving hypothalamic hamartoblastoma, hypopituitarism, cranial, and limb abnormalities. The first 2 cases represent the first apparent sibs reported with this syndrome. Patient 1 represents the first known patient with this syndrome with an abnormal karyotype.     

Polysyndactyly and asymptomatic hypothalamic hamartoma in mother and son: a variant of Pallister-Hall syndrome

We report on a 53-year-old woman and her 20-year-old son who both presented with polysyndactyly, without other external malformations or mental retardation. MRI imaging revealed, as an incidental finding, asymptomatic hypothalamic hamartomas in both patients. The siblings of both mother and son are unaffected. This family may represent an autosomal dominant variant of Pallister-Hall syndrome.     

Pallister-Hall syndrome: unreported skeletal features of a GLI3 mutation

We describe two patients with Pallister-Hall syndrome (PHS), both with evidence of a generalized skeletal dysplasia as typified by upper and lower acromesomelic limb shortening and the previously unreported fibular hypoplasia, radio-ulnar bowing, and proximal epiphyseal hypoplasia. Genomic DNA was only available for sequencing analysis in patient 2 and the mutation, c.3386_3387delTT was detected in exon 14 of the GL13 gene. It is also possible that the findings in patient 1 represent the phenotypic expression of a novel GLI3 mutation. This report further expands the PHS phenotype and raises the possibility of specific GLI3 mutations resulting in more severe skeletal features. It also suggests that PHS should be included in the differential diagnosis of antenatally ascertained acromesomelic limb shortening and bowing with fibular hypoplasia particularly in the presence of polysyndactyly.     

Metopic and sagittal synostosis in Greig cephalopolysyndactyly syndrome: five cases with intragenic mutations or complete deletions of GLI3

Greig cephalopolysyndactyly syndrome (GCPS) is a multiple congenital malformation characterised by limb and craniofacial anomalies, caused by heterozygous mutation or deletion of GLI3. We report four boys and a girl who were presented with trigonocephaly due to metopic synostosis, in association with pre- and post-axial polydactyly and cutaneous syndactyly of hands and feet. Two cases had additional sagittal synostosis. None had a family history of similar features. In all five children, the diagnosis of GCPS was confirmed by molecular analysis of GLI3 (two had intragenic mutations and three had complete gene deletions detected on array comparative genomic hybridisation), thus highlighting the importance of trigonocephaly or overt metopic or sagittal synostosis as a distinct presenting feature of GCPS. These observations confirm and extend a recently proposed association of intragenic GLI3 mutations with metopic synostosis; moreover, the three individuals with complete deletion of GLI3 were previously considered to have Carpenter syndrome, highlighting an important source of diagnostic confusion.     

GLI3‐related polydactyly: a review

GLI3 mutations are known to be associated with nine syndromes/conditions in which polydactyly is a feature. In this review, the embryology, pathogenesis, and animal models of GLI3‐related polydactyly are discussed first. This is followed by a detailed review of the genotype–phenotype correlations. Based on our review of the literature and our clinical experiences, we recommend viewing GLI3‐related syndromes/conditions as four separate entities; each characterized by a specific pattern of polydactyly. These four entities are: the preaxial polydactyly type IV‐Greig‐acrocallosal spectrum, postaxial polydactyly types A/B, Pallister–Hall syndrome (PHS), and oral‐facial‐digital overlap syndrome. We also provide illustrative clinical examples from our practice including a family with a novel GLI3 mutation causing PHS. The review also introduces the term ‘Forme Fruste’ preaxial polydactyly and gives several conclusions/recommendations including the recommendation to revise the current criteria for the clinical diagnosis of PHS.     

GLI3基因与单纯性马蹄内翻足的关联分析及其突变筛查

目的对GLU基因与单纯性马蹄内翻足进行关联分析和突变筛查，探讨GLU基因与单纯性马蹄内翻足的相关性。方法应用限制性片段长度多态性分析技术，分析84个单纯性马蹄内翻足核心家系中GLI3基因内两个单核苷酸多态（single nucleotide polymorphisms, SNP）位点的基因型，并应用ETDT软伯统计分析各SNP位点基因型与单纯性马蹄内翻足的关联；应用变性梯度凝胶电泳技术对103例单纯性马蹄内翻足患者GLI3基因的第9至12外显子进行突变筛查。结果经ETDT分析，位于GLI3基因第4外显子的cSNP rs846266差异无统计学意义（χ^2=3．3582，P〉0．05）；第14外显子的cSNP rs929387差异有统计学意义（χ^2=7．2466，P〈0．05），在单纯性马蹄内翻足核心家系中存在传递不平衡；发现1例患者及其母亲的第9外显子有108（G→A）的同义点突变。结论GLI3基因与单纯性马蹄内翻足相关，其第9至12外显子可能并非该病的突变热点。     

Cystic kidney dysplasia and polydactyly in 3 sibs with Bardet-Biedl syndrome

Two infants with cystic kidney dysplasia and polydactyly were born to consanguineous parents. One infant died at age 2 months, and the other is currently 3.5 years old. A third pregnancy was terminated following ultrasonographic visualization of large echodense fetal kidneys and polydactyly. Although none had apparent brain anomalies, they were considered to represent the Meckel syndrome. Extinguished responses on electroretinography in our 3.5-year-old patient has led to the diagnosis of Bardet-Biedl syndrome. This observation offers an opportunity to revisit the Bardet-Biedl syndrome and provides further evidence that structural renal abnormalities are characteristic of the syndrome. We wish to alert the clinician to the diagnosis of Bardet-Biedl syndrome in patients with infantile cystic kidney dysplasia. © Wiley-Liss, Inc.     

GLI3基因在单纯性马蹄内翻足发生中的调控机制

目的 探讨在单纯性马蹄内翻足发生过程中GLI3基因的凋控机制.方法 构建荧光素酶报告基因表达载体,分析大鼠Gli3基因5′侧翼启动子区域的活性.用P-Match软件预测Gli3基因上游序列中转录因子的结合位点,并通过染色质免疫沉淀实验、凝胶迁移实验验证.用RNA干扰实验以及构建Hoxd13表达载体,观察其在L6细胞中对Gli3基因表达的影响.结果 在大鼠Gli3基因序列的启动子区域发现2个Hoxd13的结合位点,染色质免疫沉淀和凝胶迁移实验证实Hoxd13结合于结合位点2上.Hoxd13表达下调时,Gli3基因表达明显上调.Hoxd13基因表达上调时,Gli3基因则表达下调.结论 在大鼠胚胎肢体发育中,Hoxd13蛋白可能与Gli3基因启动子区的Hoxd13结合位点2结合,调控Gli3的表达.     

GLI3基因在单纯性马蹄内翻足发病机制中的作用

目的 探讨GLI3基因与单纯性马蹄内翻足(idiopathic congenital talipes equinovarus,ICTEV)的相关性.方法 应用变性梯度凝胶电泳技术检测GLI3基因编码区的突变.用逆转录-PCR方法研究GLI3基因在1CTEV患者下肢的表达情况.构建ICTEV大鼠模型,应用实时定量PCR、免疫组织化学染色和蛋白质免疫印迹(Western blotting)方法研究Gli3基因在ICTEV模型鼠下肢肌肉组织中的表达.结果 在84例ICTEV患者外周静脉血中未发现GLI3基因第1～8外显子以及第13外显子存在突变.在ICTEV患者及正常人下肢拇长屈肌中均未检测到GLI3基因的表达.不论在mRNA水平还是在蛋白质水平,Gli3基因在ICTEV模型胎鼠下肢组织中的表达均明显高于正常对照胎鼠.结论 GLI3基因的编码区突变可能不是ICTEV发病的主要原因,但GLI3基因的表达异常与马蹄内翻足的发病可能有关.     

3C (cranio-cerebello-cardiac) syndrome: A recently delineated and easily recognizable congenital malformation syndrome

We report on two cases of 3C (cranio-cerebello-cardiac) syndrome. At least five previous cases are known. This recently delineated malformation syndrome is characterized by congenital anomalies of the skull, hindbrain, and heart. The anomalies include a high and prominent forehead, a hypoplastic vermis and posterior fossa cyst with or without hydrocephalus, and an atrial or atrio-ventricular septal defect with or without other heart anomalies. Most patients show a postnatal growth retardation, as well as a mild to moderate psychomotor retardation. Early death is usually in association with severe congenital heart defect. Aside from two affected sisters, the other reported cases (four girls and one boy) are sporadic cases; thus, a possible genetic nature and inheritance mode remain uncertain. Nonetheless, the possibility of an autosomal recessive mode of inheritance should be considered in the genetic counselling. © 1994 Wiley-Liss, Inc.