Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
Am J Med Genet A. 2014 Mar;164A(3):579-87. doi: 10.1002/ajmg.a.36313. Epub 2013 Dec 19.
Neurofibromatosis-Noonan syndrome (NFNS) is a rare condition with clinical features of both neurofibromatosis type 1 (NF1) and Noonan syndrome (NS). All three syndromes belong to the RASopathies, which are caused by dysregulation of the RAS-MAPK pathway. The major gene involved in NFNS is NF1, but co-occurring NF1 and PTPN11 mutations in NFNS have been reported. Knowledge about possible involvement of additional RASopathy-associated genes in NFNS is, however, very limited. We present a comprehensive clinical and molecular analysis of eight affected individuals from three unrelated families displaying features of NF1 and NFNS. The genetic etiology of the clinical phenotypes was investigated by mutation analysis, including NF1, PTPN11, SOS1, KRAS, NRAS, BRAF, RAF1, SHOC2, SPRED1, MAP2K1, MAP2K2, and CBL. All three families harbored a heterozygous NF1 variant, where the first family had a missense variant, c.5425C>T;p.R1809C, the second family a recurrent 4bp-deletion, c.6789_6792delTTAC;p.Y2264Tfs*6, and the third family a splice-site variant, c.2991-1G>A, resulting in skipping of exon 18 and an in-frame deletion of 41 amino acids. These NF1 variants have all previously been reported in NF1 patients. Surprisingly, both c.6789_6792delTTAC and c.2991-1G>A are frequently associated with NF1, but association to NFNS has, to our knowledge, not previously been reported. Our results support the notion that NFNS represents a variant of NF1, genetically distinct from NS, and is caused by mutations in NF1, some of which also cause classical NF1. Due to phenotypic overlap between NFNS and NS, we propose screening for NF1 mutations in NS patients, preferentially when café-au-lait spots are present.
神经纤维瘤病-Noonan 综合征(NFNS)是一种罕见的疾病,具有神经纤维瘤病 1 型(NF1)和 Noonan 综合征(NS)的临床特征。所有这三种综合征都属于 RAS 病,这是由 RAS-MAPK 通路的失调引起的。NFNS 主要涉及的基因是 NF1,但 NFNS 中也有 NF1 和 PTPN11 突变共存的报道。然而,关于 NFNS 中可能涉及其他 RAS 相关基因的知识非常有限。我们报告了三个无关家庭的 8 名受影响个体的综合临床和分子分析,这些个体表现出 NF1 和 NFNS 的特征。通过突变分析研究了临床表型的遗传病因,包括 NF1、PTPN11、SOS1、KRAS、NRAS、BRAF、RAF1、SHOC2、SPRED1、MAP2K1、MAP2K2 和 CBL。这三个家庭都携带有杂合性 NF1 变体,其中第一个家庭有一个错义变体,c.5425C>T;p.R1809C,第二个家庭有一个重复的 4bp 缺失,c.6789_6792delTTAC;p.Y2264Tfs*6,第三个家庭有一个剪接位点变体,c.2991-1G>A,导致外显子 18 跳过和 41 个氨基酸的框内缺失。这些 NF1 变体以前都在 NF1 患者中报道过。令人惊讶的是,c.6789_6792delTTAC 和 c.2991-1G>A 都与 NF1 密切相关,但与 NFNS 的关联,据我们所知,以前没有报道过。我们的结果支持 NFNS 代表 NF1 的一种变体,在遗传上与 NS 不同,并且是由 NF1 突变引起的,其中一些突变也会导致经典的 NF1。由于 NFNS 和 NS 之间存在表型重叠,我们建议在 NS 患者中筛查 NF1 突变,特别是当存在咖啡牛奶斑时。
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