Wieacker syndrome | |
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Other names | Intellectual disability-developmental delay-contractures syndrome |
This condition is inherited in an X-linked recessive manner. |
First being described and identified in 1985, Wieacker-Wolff syndrome is a rare, slowly progressive, genetic disorder present at birth and characterized by deformities of the joints of the feet, muscle degeneration, mild intellectual disability and an impaired ability to move certain muscles of the eyes, face and tongue. [1] Wieacker syndrome is inherited as an X-linked recessive trait. [1]
The condition is characterized by contracture of the lower joints, muscle atrophy, impaired facial muscles, mental retardation, and syndromic facies. [2] [1] Additional symptoms include stiffening of the muscles and joints of the feet, intellectual disabilities, droopy eyelids, crossed eyes, farsightedness, and abnormal curvature of the spine. [3] Depending on a person’s genotype, the severity of their symptoms will differ. For example, females tend to have milder signs of the disease, especially when heterozygous. [4]
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Wieacker syndrome is caused by a mutation in ZC4H2 on the X chromosome (Xq13-q21). [1]
There are five affected families, each with different mutations to the ZC4H2 gene. Family one has a substitution of Guanine (G) to a Cytosine (C) at basepair position 187. This leads to an amino acid change at position 63, where a leucine replaces a valine. This phenotype is the most mild because mutation only alters the secondary structure of the protein. This leads to a less stable protein that is still fully functional. [5]
Family two has a substitution of a Guanine (G) to a Adenine (A) at base pair position 593 which leads to an amino acid change from an arginine to glutamine. This phenotype is lethal at ages .5 to 8.0 years due to a change in the highly conserved zinc-finger domain which compromises the proteins function. [5]
Family three also has a lethal phenotype. Family three has a substitution of a Cytosine (C) to a Thiamine (T) as base pair position 601. This leads to an amino acid change at position 201 from a proline to serine. This phenotype is lethal from ages 1.4 weeks to 13.0 weeks because it alters the highly conserved domain of the protein which compromises its function. [5]
Families 4 and 5 have the same substitution of a Cytosine (C) to Thiamine (T) at base pair position 637. This leads to an amino acid change from Arginine to Tryptophan at amino acid position 213. This phenotype occurs near the highly conserved Carboxyl terminus of the protein. This leads to an intermediate phenotype, where females are normal except for a developmental which has been hypothesized to be caused by varying X-chromosome inactivation. [5]
In some instances in the history of the family in which the syndrome was first described, the syndrome was present at birth. The mutations were found by various methods, including whole-genome sequencing, X-chromosome exome sequencing, and direct sequencing of the ZC4H2 gene: all mutations were confirmed by Sanger sequencing and segregated with the disorder in the families. [6] There were 3 missense and 1 splice site mutations. The mutations were found by exome sequencing in some of the families. [6]
Treatment of Wieacker syndrome is typically supportive and symptomatic due to the little information physicians have on the disease. [1] Therapies such as physical therapy, surgery, speech therapy, and special education are typically used and have been beneficial for the impacted families. [1] While these management techniques cannot fully treat the disorder, they can help reduce the negative results of the symptoms and aid the families in living a semi-normal life. Clinical trials are in development regarding the disorder as well, looking to better understand Wieacker syndrome and its possible treatments. [1]
Wieacker syndrome has fewer than 30 confirmed cases, where it usually affects males, but some carrier females show mild manifestations of the disorder. [7] As of 2015, the syndrome has been reported in 5 families. [1] Prevalence and incidence rates are not fully known at this time but are spread across Germany, France, the Netherlands, Australia, and the United States. [8]
In 4 generations of a Missouri kindred, Miles and Carpenter (1991) observed 3 brothers and a male cousin with mental retardation in association with exotropia, microcephaly, distal muscle wasting, and 10 low digital arches. [9] Six women who might represent heterozygotes were found to have 8 to 10 low digital arches; 5 of these women had exotropia. [9]
A second family was found with a similar, but more severe phenotype. [5] Affected individuals presented with neonatal respiratory distress, arthrogryposis multiplex congenita, muscle weakness, and ptosis, suggesting dysfunction of neuromuscular transmission in utero. [5]
A third family identified by Hirata et al. (2013) had previously been reported by Hennekam et al. (1991). [10] [11] That family had 5 affected males in 3 sibships connected through females. Affected males had severe arthrogryposis and muscle weakness in the pre- and postnatal periods, resulting in death within the first weeks or months of life. The 1 surviving boy was had severely impaired intellectual development.
May et al. (2015) reported 3 previously unreported families with X-linked syndromic mental retardation. [12] There were 10 affected males and 10 carrier females. There was phenotypic variability between the families, but all male patients had impaired intellectual development.
Frints et al. (2019) reported 11 males from 6 unrelated families (families 1, 4-6, 9, and 19) with WRWF. [13] Two additional male patients (families 18 and 24) were sporadic cases with de novo missense variants. Some affected fetuses showed signs of the disorder in utero: these included clubfoot or rocker bottom feet, fetal hypo/akinesia, contractures, AMC, and nuchal edema.
Fragile X syndrome (FXS) is a genetic disorder characterized by mild-to-moderate intellectual disability. The average IQ in males with FXS is under 55, while about two thirds of affected females are intellectually disabled. Physical features may include a long and narrow face, large ears, flexible fingers, and large testicles. About a third of those affected have features of autism such as problems with social interactions and delayed speech. Hyperactivity is common, and seizures occur in about 10%. Males are usually more affected than females.
Myotonia is a symptom of a small handful of certain neuromuscular disorders characterized by delayed relaxation of the skeletal muscles after voluntary contraction or electrical stimulation.
MASA syndrome is a rare X-linked recessive neurological disorder on the L1 disorder spectrum belonging in the group of hereditary spastic paraplegias a paraplegia known to increase stiffness spasticity in the lower limbs. This syndrome also has two other names, CRASH syndrome and Gareis-Mason syndrome.
Arthrogryposis, describes congenital joint contracture in two or more areas of the body. It derives its name from Greek, literally meaning "curving of joints".
Primrose syndrome is a rare, slowly progressive genetic disorder that can vary symptomatically between individual cases, but is generally characterised by ossification of the external ears, learning difficulties, and facial abnormalities. It was first described in 1982 in Scotland's Royal National Larbert Institution by Dr D.A.A. Primrose.
Dyskeratosis congenita (DKC),also known as Zinsser-Engman-Cole syndrome, is a rare progressive congenital disorder with a highly variable phenotype. The entity was classically defined by the triad of abnormal skin pigmentation, nail dystrophy, and leukoplakia of the oral mucosa, but these components do not always occur. DKC is characterized by short telomeres. Some of the manifestations resemble premature ageing. The disease initially mainly affects the skin, but a major consequence is progressive bone marrow failure which occurs in over 80%, causing early mortality.
X-linked spinal muscular atrophy type 2, also known as arthrogryposis multiplex congenita X-linked type 1 (AMCX1), is a rare neurological disorder involving death of motor neurons in the anterior horn of spinal cord resulting in generalised muscle wasting (atrophy). The disease is caused by a mutation in UBA1 gene and is passed in an X-linked recessive manner by carrier mothers to affected sons.
Lujan–Fryns syndrome (LFS) is an X-linked genetic disorder that causes mild to moderate intellectual disability and features described as Marfanoid habitus, referring to a group of physical characteristics similar to those found in Marfan syndrome. These features include a tall, thin stature and long, slender limbs. LFS is also associated with psychopathology and behavioral abnormalities, and it exhibits a number of malformations affecting the brain and heart. The disorder is inherited in an X-linked dominant manner, and is attributed to a missense mutation in the MED12 gene. There is currently no treatment or therapy for the underlying MED12 malfunction, and the exact cause of the disorder remains unclear.
Wilson-Turner syndrome (WTS), also known as mental retardation X linked syndromic 6 (MRXS6), and mental retardation X linked with gynecomastia and obesity is a congenital condition characterized by intellectual disability and associated with childhood-onset obesity. It is found to be linked to the X chromosome and caused by a mutation in the HDAC8 gene, which is located on the q arm at locus 13.1. Individuals with Wilson–Turner syndrome have a spectrum of physical characteristics including dysmorphic facial features, hypogonadism, and short stature. Females generally have milder phenotypes than males. This disorder affects all demographics equally and is seen in less than one in one million people.
Lethal congenital contracture syndrome 1 (LCCS1), also called Multiple contracture syndrome, Finnish type, is an autosomal recessive genetic disorder characterized by total immobility of a fetus, detectable at around the 13th week of pregnancy. LCCS1 invariably leads to prenatal death before the 32nd gestational week. LCCS1 is one of 40 Finnish heritage diseases. It was first described in 1985 and since then, approximately 70 cases have been diagnosed.
Malpuech facial clefting syndrome, also called Malpuech syndrome or Gypsy type facial clefting syndrome, is a rare congenital syndrome. It is characterized by facial clefting, a caudal appendage, growth deficiency, intellectual and developmental disability, and abnormalities of the renal system (kidneys) and the male genitalia. Abnormalities of the heart, and other skeletal malformations may also be present. The syndrome was initially described by Georges Malpuech and associates in 1983. It is thought to be genetically related to Juberg-Hayward syndrome. Malpuech syndrome has also been considered as part of a spectrum of congenital genetic disorders associated with similar facial, urogenital and skeletal anomalies. Termed "3MC syndrome", this proposed spectrum includes Malpuech, Michels and Mingarelli-Carnevale (OSA) syndromes. Mutations in the COLLEC11 and MASP1 genes are believed to be a cause of these syndromes. The incidence of Malpuech syndrome is unknown. The pattern of inheritance is autosomal recessive, which means a defective (mutated) gene associated with the syndrome is located on an autosome, and the syndrome occurs when two copies of this defective gene are inherited.
Floating–Harbor syndrome, also known as Pelletier–Leisti syndrome, is a rare disease with fewer than 50 cases described in the literature. It is usually diagnosed in early childhood and is characterized by the triad of proportionate short stature with delayed bone age, characteristic facial appearance, and delayed speech development. Although its cause is unknown, it is thought to result from genetic mutation, and diagnosis is established by the presence of a heterozygous SRCAP mutation in those with clinical findings of FHS.
Bruck syndrome is characterized as the combination of arthrogryposis multiplex congenita and osteogenesis imperfecta. Both diseases are uncommon, but concurrence is extremely rare which makes Bruck syndrome very difficult to research. Bruck syndrome is thought to be an atypical variant of osteogenesis imperfecta most resembling type III, if not its own disease. Multiple gene mutations associated with osteogenesis imperfecta are not seen in Bruck syndrome. Many affected individuals are within the same family, and pedigree data supports that the disease is acquired through autosomal recessive inheritance. Bruck syndrome has features of congenital contractures, bone fragility, recurring bone fractures, flexion joint and limb deformities, pterygia, short body height, and progressive kyphoscoliosis. Individuals encounter restricted mobility and pulmonary function. A reduction in bone mineral content and larger hydroxyapatite crystals are also detectable Joint contractures are primarily bilateral and symmetrical, and most prone to ankles. Bruck syndrome has no effect on intelligence, vision, or hearing.
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ZC4H2 is a protein-coding gene located on the X-chromosome. This gene encodes a protein which is a member of the so-called zinc finger domain-containing protein family. There is currently very limited understanding about the ZC4H2 gene and its protein function.
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Spinal muscular atrophy with lower extremity predominance 2B (SMALED2B) is a rare neuromuscular disorder characterised by generalised muscle weakness.
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