Steiner Matthew B, Vengoechea Jaime, Collins Ronnie Thomas
Division of Pediatric Cardiology, Arkansas Children's Hospital, Little Rock, USA.
J Med Case Rep. 2013 Dec 30;7:287. doi: 10.1186/1752-1947-7-287.
The pentalogy of Cantrell is rare clustering of congenital defects, first described by Cantrell and colleagues in 1958. The exact pathogenesis for the pentalogy remains unknown and no specific genetic abnormalities have been correlated; however, a failure of embryogenesis has been suspected. The microduplication of chromosome 15q21.3 (57,529,846 to 58,949,448) found in our patient with pentalogy of Cantrell has not been described previously.
We describe a case of a newborn Caucasian male baby with prenatally diagnosed pentalogy of Cantrell and a novel maternally inherited copy number variant detected by chromosome microarray analysis. Among the genes within the duplicated region is ALDH1A2, encoding the enzyme retinaldehyde dehydrogenase type 2.
Vital for retinoic acid synthesis during early development, ALDH1A2 has previously been demonstrated in animal models to have a strong association with congenital heart disease and diaphragmatic hernia, two key elements comprising pentalogy of Cantrell. It is possible that perturbation of retinoic acid levels during development secondary to this microduplication could underlie the pathology observed in the current case of pentalogy of Cantrell.
坎特雷尔五联症是一种罕见的先天性缺陷集群,于1958年由坎特雷尔及其同事首次描述。该五联症的确切发病机制尚不清楚,且未发现与之相关的特定基因异常;然而,有人怀疑是胚胎发育失败所致。我们在一名患有坎特雷尔五联症的患者中发现的15q21.3染色体微重复(57,529,846至58,949,448)此前尚未见报道。
我们描述了一例产前诊断为坎特雷尔五联症的白人男婴病例,并通过染色体微阵列分析检测到一种新的母系遗传拷贝数变异。重复区域内的基因包括ALDH1A2,它编码2型视黄醛脱氢酶。
ALDH1A2在早期发育过程中对视黄酸合成至关重要,此前在动物模型中已证明它与先天性心脏病和膈疝密切相关,而这两者是构成坎特雷尔五联症的两个关键要素。这种微重复继发的发育过程中视黄酸水平的扰动可能是当前坎特雷尔五联症病例中观察到的病理现象的基础。