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      Síndrome de Robinow asociado a insuficiencia renal crónica en fase terminal Translated title: Robinow syndrome associated with chronic kidney failure in terminal stage

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          Abstract

          RESUMEN Se describe el caso clínico de un adolescente de 18 años con antecedente patológico de una operación por hipertelorismo en su primer año de vida, quien fue asistido en el Servicio de Nefrología del Hospital Infantil Docente Norte Dr. Juan de la Cruz Martínez Maceira de Santiago de Cuba, debido a una disminución marcada de la función renal, por lo cual requirió terapias sustitutivas. Su estado persistió por más de 3 meses y se consideró como una insuficiencia renal crónica en fase terminal. Se realizaron varios exámenes complementarios en busca de la causa y se interconsultó con otras especialidades, como la de Genética Clínica, por la presencia de trastornos dismórficos; finalmente, se diagnosticó el síndrome de Robinow. El paciente permaneció con hemodiálisis por 2 años hasta que su condición fue estable para recibir un trasplante de riñón.

          Translated abstract

          ABSTRACT The case report of an 18 years adolescent is described with pathological history of a surgery due to hypertelorism in his first year of life who was assisted in the Nephrology Service of Dr. Juan de la Cruz Martínez Maceira Northern Teaching Children Hospital in Santiago de Cuba, due to a marked decrease of the renal function, reason why he required substitute therapies. His condition persisted for more than 3 months and it was considered as a chronic kidney failure in end stage. Several complementary exams were carried out to find out the cause and other specialties participated in the diagnosis, as Clinical Genetics, due to the presence of dysmorphic disorders; finally, Robinow syndrome was diagnosed. The patient remained with hemodialysis for 2 years until her condition was stable to receive a renal transplant.

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          Most cited references10

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          DVL3 Alleles Resulting in a -1 Frameshift of the Last Exon Mediate Autosomal-Dominant Robinow Syndrome.

          Robinow syndrome is a rare congenital disorder characterized by mesomelic limb shortening, genital hypoplasia, and distinctive facial features. Recent reports have identified, in individuals with dominant Robinow syndrome, a specific type of variant characterized by being uniformly located in the penultimate exon of DVL1 and resulting in a -1 frameshift allele with a premature termination codon that escapes nonsense-mediated decay. Here, we studied a cohort of individuals who had been clinically diagnosed with Robinow syndrome but who had not received a molecular diagnosis from variant studies of DVL1, WNT5A, and ROR2. Because of the uniform location of frameshift variants in DVL1-mediated Robinow syndrome and the functional redundancy of DVL1, DVL2, and DVL3, we elected to pursue direct Sanger sequencing of the penultimate exon of DVL1 and its paralogs DVL2 and DVL3 to search for potential disease-associated variants. Remarkably, targeted sequencing identified five unrelated individuals harboring heterozygous, de novo frameshift variants in DVL3, including two splice acceptor mutations and three 1 bp deletions. Similar to the variants observed in DVL1-mediated Robinow syndrome, all variants in DVL3 result in a -1 frameshift, indicating that these highly specific alterations might be a common cause of dominant Robinow syndrome. Here, we review the current knowledge of these peculiar variant alleles in DVL1- and DVL3-mediated Robinow syndrome and further elucidate the phenotypic features present in subjects with DVL1 and DVL3 frameshift mutations.
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            Mutations in DVL1 cause an osteosclerotic form of Robinow syndrome.

            Robinow syndrome (RS) is a phenotypically and genetically heterogeneous condition that can be caused by mutations in genes encoding components of the non-canonical Wnt signaling pathway. In contrast, germline mutations that act to increase canonical Wnt signaling lead to distinctive osteosclerotic phenotypes. Here, we identified de novo frameshift mutations in DVL1, a mediator of both canonical and non-canonical Wnt signaling, as the cause of RS-OS, an RS subtype involving osteosclerosis, in three unrelated individuals. The mutations all delete the DVL1 C terminus and replace it, in each instance, with a novel, highly basic sequence. We showed the presence of mutant transcript in fibroblasts from one individual with RS-OS and demonstrated unimpaired protein stability with transfected GFP-tagged constructs bearing a frameshift mutation. In vitro TOPFlash assays, in apparent contradiction to the osteosclerotic phenotype, revealed that the mutant allele was less active than the wild-type allele in the canonical Wnt signaling pathway. However, when the mutant and wild-type alleles were co-expressed, canonical Wnt activity was 2-fold higher than that in the wild-type construct alone. This work establishes that DVL1 mutations cause a specific RS subtype, RS-OS, and that the osteosclerosis associated with this subtype might be the result of an interaction between the wild-type and mutant alleles and thus lead to elevated canonical Wnt signaling.
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              Abnormal WNT5A Signaling Causes Mandibular Hypoplasia in Robinow Syndrome.

              The study of rare genetic diseases provides valuable insights into human gene function. Here, we investigate dominant Robinow syndrome (RS), which affects the WNT5A signaling pathway. Autosomal dominant RS is caused by missense mutations in WNT5A or nonsense mutations in the adaptor protein DVL1 or DVL3. The recessive form of the disease is caused by loss-of-function mutations in the receptor ROR2. RS is characterized by hypertelorism, midface, and mandibular hypoplasia. Here, we focus on the missense mutations in WNT5A, since the impact on function is difficult to predict from in silico analysis. We used chicken embryo to express wild-type or 2 mutant versions of human WNT5A in the mandible and then examined the morphologic, cellular, and molecular effects. The 3 experimental viruses-wt WNT5A, WNT5AC83S, or WNT5AC182R-all caused shortening of the mandible on the injected side as compared with GFP controls. Although the phenotypes initially appeared similar, we uncovered specific disruption of chondrocyte polarity and shape, inhibition of cell migration, differences in target gene expression, and absence of JNK signaling only in the presence of mutant viruses. In addition, the missense mutations do not appear to block receptor binding, since in paracrine experiments, the mutant protein inhibits cell migration. In this study, we ruled out a straightforward gain or loss of function caused by the WNT5A missense mutations. Instead, the mutations are likely redirecting WNT signaling away from JNK-PCP toward other noncanonical pathways. We conclude that in RS, WNT5A missense mutations have dominant neomorphic effects that interfere with the function of the wild-type protein.
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                Author and article information

                Journal
                san
                MEDISAN
                MEDISAN
                Centro Provincial de Ciencias Médicas, Santiago de Cuba (Santiago de Cuba, , Cuba )
                1029-3019
                April 2021
                : 25
                : 2
                : 460-469
                Affiliations
                [1] Santiago de Cuba orgnameUniversidad de Ciencias Médicas orgdiv1Hospital Infantil Docente Norte Dr. Juan de la Cruz Martínez Maceira Cuba
                Article
                S1029-30192021000200460 S1029-3019(21)02500200460
                8ea7c30d-1722-43e7-8a0b-3610a871e373

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 25 September 2020
                : 02 February 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 10, Pages: 10
                Product

                SciELO Cuba

                Categories
                CASOS CLÍNICOS

                Robinow syndrome,diálisis renal,fallo renal crónico,insuficiencia renal crónica,síndrome de Robinow,renal dialysis,chronic kidney failure,chronic renal insufficiency

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