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[Prenatal diagnosis of cutaneous genetic diseases by the study of fetal DNA].

There has been considerable progress in chromosome mapping and gene identification in several severe hereditary skin diseases, leading to changes in genetic counseling. It is now possible to propose antenatal diagnosis to couples at risk based on an analysis of foetal DNA from trophoblast biopsies performed as early as the 9th week of gestation. Antenatal can be made by direct analysis based on identifying the mutation known in the family at risk or on indirect analysis based on the linkage disequilibrium of the allele or alleles associated with the disease in the family at risk. This method has already been shown to be effective in recessive dystrophic bullous epidermolysis, lethal Herlitz's junctional bullous epidermolysis, bullous ichthyosiform hereditary erythroderma, von Recklinghausen's neurofibromatosis, tyrosinase negative oculocutaneous albinism, Gorlin's syndrome, anhidrotic ectodermic dysplasia and Menkes disease. These techniques will replace microscopic examination of ultrastructure in foetal skin biopsies performed at 20 weeks gestation. They can also be applied to diseases where the antenatal diagnosis now relies on enzyme function tests or DNA distribution. Improving genetic counselling in these diseases requires the identification of the implicated genes, identification of the causal mutations in the families at risk and development of genetic markers for these diseases.

DNA↗

Ellis-van Creveld syndrome. An inbred kindred with five cases.

Five additional cases of a kindred with inbred Ellis-van Creveld syndrome are reported. Ectodermal dysplasia polydactyly, chondroectodermal dysplasia and possibly congenital heart diseases were present in all our cases. Cephalometric radiographs from one patient showed an enlargement of the mentum-groove-labial distance. The diagnosis of two individuals was performed by clinical and radiological examinations. An autosomal recessive mode of inheritance is strongly suggested by their pedigree.

Anthropometry↗

Pseudomelanosis duodeni in an adolescent male: case report and review of the literature.

Pseudomelanosis duodeni is rarely seen in children. It manifests endoscopically as peppery speckles in the duodenal mucosa. This pigment corresponds principally to accumulation of ferrous sulfide in macrophages within the lamina propria. We report the case of a 16-year-old boy with ectodermal dysplasia who underwent renal transplantation for vesicoureteral reflux and later developed epigastric pain. Endoscopic and pathologic findings in the duodenal mucosa were typical of pseudomelanosis duodeni. A review of the literature reveals shared clinical features among reported adult and pediatric cases, including chronic renal failure, use of antihypertensive medication and oral iron supplementation, and/or presence of gastric hemorrhage.

Adolescent↗

[A case of Ellis-van Creveld syndrome with partial atrioventricular septal defect and double orifice mitral valve].

Ellis-van Creveld Syndrome (ECS) is characterized by chondrodysplasia, ectodermal dysplasia, polydactyly, and congenital cardiac defects. As congenital cardiac defects, single atrium and endocardial cusion defect are frequent in literatures. We described a case, a 68-year-old woman, presenting with ECS with partial atrioventricular septal defect and double orifice mitral valve. The partial atrioventricular septal defect was repaired by closure with a Dacron patch. The accessory orifice was located at the anterior cusp of the mitral valve, which was left, untouched, because no regurgitation had been detected preoperatively. Her postoperative course was uneventful, and the patient was discharged on 25th postoperative day.

Aged↗

[Hereditary diseases with tooth anomalies and their causal genes].

In this review, we describe the current knowledge and the advances in research on human genes whose defect leads to dental anomalies. Recently, it was demonstrated that a missense mutation of a human homeobox MSX1 gene causes autosomal dominant agenesis of second premolars and third molars. X-linked anhidrotic ectodermal dysplasia (EDA), characterized by abnormal hair, teeth, and sweat glands, was demonstrated to be caused by a mutation in a novel transmembrane protein gene that is expressed in epithelial cells and in other adult and fetal tissues. The autosomal dominant Rieger syndrome (RS) manifests hypodontia, adontia, iridogoniodysgenesis and umbilical anomalies. Recently, a novel homeobox gene, RIEG, of Otx family was cloned as a causal gene of RS. The several mutations have been reported on the genes causing hypophosphatasia, which is characterized by defective mineralization of the skeletal and dental structures. An autosomal dominant dentinogenesis imperfecta (DI) is mostly associated with osteogenesis imperfecta (OI). Most patients with DI have mutations in either the COL1A1 or COL1A2 genes of type I collagen. Amelogenesis imperfecta (AI) is a diverse group of hereditary disorders characterized by a variety of developmental enamel defects including hypoplasia and hypomineralization, some of which have been revealed to be associated with defective amelogenin genes.

Alkaline Phosphatase↗

Mixed clefting type in Rapp-Hodgkin syndrome.

Mixed clefting type (MCT) is the rare occurrence of cleft lip, with or without cleft palate, and cleft palate alone in the same pedigree. Here we present a family with Rapp-Hodgkin syndrome (RHS) that manifests MCT, and use this rare finding to suggest that RHS may be related not only to phenotypically similar syndromes, but seemingly dissimilar ones as well. RHS has obvious phenotypic overlap with other ectodermal dysplasia-clefting syndromes (EDCS), such as ectrodactyly-ectodermal dysplasia-clefting syndrome (EEC) and ankyloblepharon-ectodermal dysplasia-clefting syndrome (AEC), all of which show MCT. MCT is also found in the allelic disorders van der Woude syndrome (VDW) and popliteal-pterygium syndrome (PPS). Therefore, while VDW and PPS have little clinical overlap with the EDCS, the common finding of MCT may indicate closer relationships at the developmental or genetic level.

Abnormalities, Multiple↗

Mechanisms of transcriptional repression of cell-cycle G2/M promoters by p63.

p63 is a developmentally regulated transcription factor related to p53, which activates and represses specific genes. The human AEC (Ankyloblepharon-Ectodermal dysplasia-Clefting) and EEC (Ectrodactyly-Ectodermal dysplasia-Cleft lip/palate) syndromes are caused by missense mutations of p63, within the DNA-binding domain (EEC) or in the C-terminal sterile alpha motif domain (AEC). We show here that p63 represses transcription of cell-cycle G(2)/M genes by binding to multiple CCAAT core promoters in immortalized and primary keratinocytes. The CCAAT-activator NF-Y and DeltaNp63alpha are associated in vivo and a conserved alpha-helix of the NF-YC histone fold is required. p63 AEC mutants, but not an EEC mutant, are incapable to bind NF-Y. DeltaNp63alpha, but not the AEC mutants repress CCAAT-dependent transcription of G(2)/M genes. Chromatin immunoprecipitation recruitment assays establish that the AEC mutants are not recruited to G(2)/M promoters, while normally present on 14-3-3sigma, which contains a sequence-specific binding site. Surprisingly, the EEC C306R mutant activates transcription. Upon keratinocytes differentiation, NF-Y and p63 remain bound to G(2)/M promoters, while HDACs are recruited, histones deacetylated, Pol II displaced and transcription repressed. Our data indicate that NF-Y is a molecular target of p63 and that inhibition of growth activating genes upon differentiation is compromised by AEC missense mutations.

CCAAT-Binding Factor↗

Omphalocele and focal dermal hypoplasia.

A case of focal dermal hypoplasia associated with a giant omphalocele in a neonate is presented. The omphalocele was treated successfully by staged repair with Teflon mesh. The Teflon mesh was well incorporated into the fascial margins of the rectus muscle and the sac, and provided a stable abdominal wall for a long period of time. Focal dermal hypoplasia is a rare syndrome with widespread dysplasia of mesodermal and ectodermal tissues. Its most characteristic change in hypoplasia of the dermal connective tissue. From the experience of staged repair of omphalocele in this case, it seems that connective tissue reaction of the tissues is not deficient in this syndrome. This paper is the second case report of this syndrome with omphalocele in the world literature.

Abnormalities, Multiple↗