SCARF syndrome | |
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Other names | Skeletal abnormalities, Cutis laxa, craniostenosis, Ambiguous genitalia, Retardation, and Facial abnormalities [1] |
This condition is inherited in an X-linked recessive manner | |
Usual onset | Infancy |
SCARF syndrome is a rare syndrome characterized by skeletal abnormalities, cutis laxa, craniostenosis, ambiguous genitalia, psychomotor retardation, and facial abnormalities. These characteristics are what make up the acronym SCARF. [2] It shares some features with Lenz-Majewski hyperostotic dwarfism. It is a very rare disease with an incidence rate of approximately one in a million newborns. [3] It has been clinically described in two males who were maternal cousins, as well as a 3-month-old female. [4] [3] Babies affected by this syndrome tend to have very loose skin, giving them an elderly facial appearance. Possible complications include dyspnea, abdominal hernia, heart disorders, joint disorders, and dislocations of multiple joints. [3] It is believed that this disease's inheritance is X-linked recessive. [4]
The most characteristic signs and symptoms of SCARF syndrome are the ones described by the acronym. This includes skeletal abnormalities, cutis laxa, craniostenosis, ambiguous genitalia, psychomotor retardation, and facial abnormalities. [4] The severity of the symptoms will vary from person to person. [5] Symptoms will present similarly in both males and females, other than specific genitourinary symptoms.
(Symptoms were obtained from OMIM catalog [5] )
While the specific cause of SCARF syndrome is unknown, it has been deemed as a genetic disorder. It is believed to be typically inherited, and transmitted as both a recessive and dominant gene. [8]
The exact genetic mutation responsible for SCARF syndrome is unknown at this time. However, the mode of inheritance is perceived to be X-linked recessive because the first two cases reported of this syndrome were in two male cousins, who were related through their mothers. [8] This means that the gene that is associated with this disorder is located on the X chromosome. [9] Since males have only one X chromosome, only a single mutation is needed to cause this disorder. In contrast, females would require a mutation on both of their X chromosomes, which is a very rare occurrence. Therefore, SCARF syndrome and X-linked recessive disorders are more common in males. [9]
Cutis laxa, one of the most common symptoms associated with SCARF syndrome, is caused by mutations in several different genes. These genes include ATP6V0A2 , ATP7A , EFEMP2 , ELN, and FBLN5. These genes are responsible for elastic fibers, specifically how they are formed and their function. Elastic fibers allow the skin to stretch, help the lungs expand and contract, as well assist arteries in managing blood flow at high blood pressures. The mode of inheritance for cutis laxa may be X-linked, autosomal dominant, or autosomal recessive. Cutis laxa is known to be the cause of many of the complications associated with SCARF syndrome such as congestive heart failure, respiratory failure, and dysfunction of gastrointestinal and urinary tract. [10]
The diagnosis relies on clinical presentations, physical examination, extensive evaluation of past medical history and family history, and karyotype testing. A 46,XX compatibility is an expected finding of the karyotype test. Laboratory tests and diagnostic imaging are typically insignificant for diagnosis. The relationship of the parents as well as family history of X-linked, autosomal dominant, and autosomal disorders should be considered to confirm SCARF syndrome. [3]
Due to the fact that the syndrome is a genetic condition, there is no specific cure for this syndrome. Treatment is not for the disease itself, but more for management of the associated signs and symptoms of SCARF syndrome and its complications.
The main risk factor is previous family history. This does not guarantee that one will inherit the disease, but it is much more likely compared to someone with no family history. No other risk factors have been identified. Due to this reason, there are not many preventative measures that can be done.
If there is family history of the syndrome, genetic counseling should be considered before planning children to assess the risk of passing the disease onto future generations. Regular blood tests and physical examinations should be done as well to ensure no change in health status. [9]
The prognosis of SCARF syndrome depends on the severity of the signs and symptoms experienced, as well as if there are any associated complications. If the symptoms are mild, the prognosis will be better than that of someone with symptoms that are severe. There is no general prognosis for SCARF syndrome and it should be assessed independently for each case. [9]
This syndrome is very rare with a prevalence rate of less than 1/1000000 worldwide. [11] The age of onset is typically neonatal or during infancy, but there has been a case reported in a 7-year-old male as well. [11] [8] There is no evidence that the syndrome is more prevalent in a specific ethnicity, but it is more prevalent in males due to its X-linked recessive inheritance. Since males only have one X chromosome, this means that only one mutation is required for the syndrome to be inherited. Females have two X chromosomes, which means that the mutation must be present on both chromosomes in order to be inherited. [9]
There is no current research exclusive to SCARF syndrome. However, research is being actively conducted on finding a treatment and prevention method for both inherited and acquired genetic disorders. [9] This includes research in the Netherlands on the genetic causes of facial abnormalities and its associated complications and symptoms. [12] [13] The study involves the identification of new casual genes related to craniosynostosis including EFNB1 and TCF12 as well as genes involved in rare craniofacial malformations, including ALX3 and RAB23. This research can help identify other genes possibly linked to the development of SCARF syndrome. There is a current clinical trial in the United Kingdom that involves the use of Sarilumab injections for the treatment of musculoskeletal and connective tissue disorders. [14] This clinical trial has the potential of developing a treatment that could be applied to numerous disorders of the musculoskeletal system and connective tissue, such as SCARF syndrome.
A genetic disorder is a health problem caused by one or more abnormalities in the genome. It can be caused by a mutation in a single gene (monogenic) or multiple genes (polygenic) or by a chromosomal abnormality. Although polygenic disorders are the most common, the term is mostly used when discussing disorders with a single genetic cause, either in a gene or chromosome. The mutation responsible can occur spontaneously before embryonic development, or it can be inherited from two parents who are carriers of a faulty gene or from a parent with the disorder. When the genetic disorder is inherited from one or both parents, it is also classified as a hereditary disease. Some disorders are caused by a mutation on the X chromosome and have X-linked inheritance. Very few disorders are inherited on the Y chromosome or mitochondrial DNA.
Weissenbacher–Zweymuller syndrome (WZS), also called Pierre-Robin syndrome with fetal chondrodysplasia, is an autosomal recessive congenital disorder, linked to mutations in the COL11A2 gene, which codes for the α2 strand of collagen type XI. It is a collagenopathy, types II and XI disorder. The condition was first characterized in 1964 by G. Weissenbacher and Ernst Zweymüller.
Jackson–Weiss syndrome (JWS) is a genetic disorder characterized by foot abnormalities and the premature fusion of certain bones of the skull (craniosynostosis), which prevents further growth of the skull and affects the shape of the head and face. This genetic disorder can also sometimes cause intellectual disability and crossed eyes. It was characterized in 1976.
3-Methylglutaconic aciduria (MGA) is any of at least five metabolic disorders that impair the body's ability to make energy in the mitochondria. As a result of this impairment, 3-methylglutaconic acid and 3-methylglutaric acid build up and can be detected in the urine.
Fucosidosis is a rare lysosomal storage disorder in which the FUCA1 gene experiences mutations that severely reduce or stop the activity of the alpha-L-fucosidase enzyme. The result is a buildup of complex sugars in parts of the body, which leads to death. Fucosidosis is one of nine identified glycoprotein storage diseases. The gene encoding the alpha-fucosidase, FUCA 1, was found to be located to the short arm of chromosome 1p36 - p34, by Carrit and co-workers, in 1982.
3C syndrome is a rare condition whose symptoms include heart defects, cerebellar hypoplasia, and cranial dysmorphism. It was first described in the medical literature in 1987 by Ritscher and Schinzel, for whom the disorder is sometimes named.
Young–Simpson syndrome (YSS) is a rare congenital disorder with symptoms including hypothyroidism, heart defects, facial dysmorphism, cryptorchidism in males, hypotonia, intellectual disability, and postnatal growth retardation.
Vici syndrome, also called immunodeficiency with cleft lip/palate, cataract, hypopigmentation and absent corpus callosum, is a rare autosomal recessive congenital disorder characterized by albinism, agenesis of the corpus callosum, cataracts, cardiomyopathy, severe psychomotor retardation, seizures, immunodeficiency and recurrent severe infections. To date, about 50 cases have been reported.
Keutel syndrome (KS) is a rare autosomal recessive genetic disorder characterized by abnormal diffuse cartilage calcification, hypoplasia of the mid-face, peripheral pulmonary stenosis, hearing loss, short distal phalanges (tips) of the fingers and mild mental retardation. Individuals with KS often present with peripheral pulmonary stenosis, brachytelephalangism, sloping forehead, midface hypoplasia, and receding chin. It is associated with abnormalities in the gene coding for matrix gla protein, MGP. Being an autosomal recessive disorder, it may be inherited from two unaffected, abnormal MGP-carrying parents. Thus, people who inherit two affected MGP alleles will likely inherit KS.
Frontonasal dysplasia (FND) is a congenital malformation of the midface. For the diagnosis of FND, a patient should present at least two of the following characteristics: hypertelorism, a wide nasal root, vertical midline cleft of the nose and/or upper lip, cleft of the wings of the nose, malformed nasal tip, encephalocele or V-shaped hair pattern on the forehead. The cause of FND remains unknown. FND seems to be sporadic (random) and multiple environmental factors are suggested as possible causes for the syndrome. However, in some families multiple cases of FND were reported, which suggests a genetic cause of FND.
3-M syndrome or 3M3 is a rare hereditary disorder characterized by severe growth retardation, facial dysmorphia, and skeletal abnormalities. The name 3-M is derived from the initials of the three researchers who first identified it: Miller, McKusick, and Malvaux and report their findings in the medical literature in 1972. Mutations in any one of the following three genes: CUL7, OBSL1, and CCDC8 are responsible for the occurrence of this disorder. It is inherited through an autosomal recessive pattern and considered very rare, so far less than 100 cases worldwide have been identified. Diagnosis is based on the presence of clinical features. Genetic testing can confirm the diagnosis and identify the specific gene involved. Treatment is aimed at addressing the growth and skeletal problems and may include surgical bone lengthening, adaptive aids, and physical therapy. An endocrinologist may assist with growth hormone replacement and appropriate evaluations during puberty.
Gerodermia osteodysplastica (GO) is a rare autosomal recessive connective tissue disorder included in the spectrum of cutis laxa syndromes.
Wrinkly skin syndrome(WSS) is a rare genetic condition characterized by sagging, wrinkled skin, low skin elasticity, and delayed fontanel (soft spot) closure along with a range of other symptoms. The disorder exhibits an autosomal recessive inheritance pattern with mutations in the ATP6V0A2 gene, leading to abnormal glycosylation events. There are only about 30 known cases of WSS as of 2010. Given its rarity and symptom overlap to other dermatological conditions, reaching an accurate diagnosis is difficult and requires specialized dermatological testing. Limited treatment options are available but long-term prognosis is variable from patient-to-patient, on the basis of individual case studies. Some skin symptoms recede with increasing age while progressive neurological advancement of the disorder causes seizures and mental deterioration later in life for some patients.
Smith–Fineman–Myers syndrome (SFMS1) is a congenital disorder that causes birth defects. This syndrome was named after Richard D. Smith, Robert M. Fineman and Gart G. Myers who discovered it around 1980.
Roberts syndrome, or sometimes called pseudothalidomide syndrome, is an extremely rare autosomal recessive genetic disorder that is characterized by mild to severe prenatal retardation or disruption of cell division, leading to malformation of the bones in the skull, face, arms, and legs.
De Barsy syndrome is a rare autosomal recessive genetic disorder. Symptoms include cutis laxa as well as other eye, musculoskeletal, and neurological abnormalities. It is usually progressive, manifesting side effects that can include clouded corneas, cataracts, short stature, dystonia, or progeria.
Baller–Gerold syndrome (BGS) is a rare genetic syndrome that involves premature fusion of the skull bones and malformations of facial, forearm and hand bones. The symptoms of Baller–Gerold syndrome overlap with features of a few other genetics disorders: Rothmund–Thomson syndrome and RAPADILINO syndrome. The prevalence of BGS is unknown, as there have only been a few reported cases, but it is estimated to be less than 1 in a million. The name of the syndrome comes from the researchers Baller and Gerold who discovered the first three cases.
Oto-palato-digital syndrome is the generalised term for two conditions, oto-palato-digital syndrome type I (OPD1) and oto-palato-digital syndrome type II (OPD2), that are both X-linked recessive genetic disorders with overlapping phenotypes. The most severe phenotypes of each syndrome occur only in males, with females generally having attenuated forms of the condition, although this does not apply to all individual cases. Some writers conceptualise oto-palato-digital syndrome as a spectrum disorder including two similarly-presenting genetic syndromes, frontometaphyseal dysplasia and Melnick-Needles syndrome.
Filippi syndrome, also known as Syndactyly Type I with Microcephaly and Mental Retardation, is a very rare autosomal recessive genetic disease. Only a very limited number of cases have been reported to date. Filippi Syndrome is associated with diverse symptoms of varying severity across affected individuals, for example malformation of digits, craniofacial abnormalities, intellectual disability, and growth retardation. The diagnosis of Filippi Syndrome can be done through clinical observation, radiography, and genetic testing. Filippi Syndrome cannot be cured directly as of 2022, hence the main focus of treatments is on tackling the symptoms observed on affected individuals. It was first reported in 1985.