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内分泌学机制:身材矮小的新型遗传病因

MECHANISMS IN ENDOCRINOLOGY: Novel genetic causes of short stature.

作者信息

Wit Jan M, Oostdijk Wilma, Losekoot Monique, van Duyvenvoorde Hermine A, Ruivenkamp Claudia A L, Kant Sarina G

机构信息

Departments of PaediatricsClinical GeneticsLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands

Departments of PaediatricsClinical GeneticsLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.

出版信息

Eur J Endocrinol. 2016 Apr;174(4):R145-73. doi: 10.1530/EJE-15-0937. Epub 2015 Nov 17.

Abstract

The fast technological development, particularly single nucleotide polymorphism array, array-comparative genomic hybridization, and whole exome sequencing, has led to the discovery of many novel genetic causes of growth failure. In this review we discuss a selection of these, according to a diagnostic classification centred on the epiphyseal growth plate. We successively discuss disorders in hormone signalling, paracrine factors, matrix molecules, intracellular pathways, and fundamental cellular processes, followed by chromosomal aberrations including copy number variants (CNVs) and imprinting disorders associated with short stature. Many novel causes of GH deficiency (GHD) as part of combined pituitary hormone deficiency have been uncovered. The most frequent genetic causes of isolated GHD are GH1 and GHRHR defects, but several novel causes have recently been found, such as GHSR, RNPC3, and IFT172 mutations. Besides well-defined causes of GH insensitivity (GHR, STAT5B, IGFALS, IGF1 defects), disorders of NFκB signalling, STAT3 and IGF2 have recently been discovered. Heterozygous IGF1R defects are a relatively frequent cause of prenatal and postnatal growth retardation. TRHA mutations cause a syndromic form of short stature with elevated T3/T4 ratio. Disorders of signalling of various paracrine factors (FGFs, BMPs, WNTs, PTHrP/IHH, and CNP/NPR2) or genetic defects affecting cartilage extracellular matrix usually cause disproportionate short stature. Heterozygous NPR2 or SHOX defects may be found in ∼3% of short children, and also rasopathies (e.g., Noonan syndrome) can be found in children without clear syndromic appearance. Numerous other syndromes associated with short stature are caused by genetic defects in fundamental cellular processes, chromosomal abnormalities, CNVs, and imprinting disorders.

摘要

快速的技术发展,尤其是单核苷酸多态性阵列、阵列比较基因组杂交和全外显子组测序,已导致发现许多生长发育迟缓的新遗传病因。在本综述中,我们根据以骨骺生长板为中心的诊断分类,讨论其中一些病因。我们依次讨论激素信号传导、旁分泌因子、基质分子、细胞内途径和基本细胞过程中的疾病,随后讨论染色体畸变,包括拷贝数变异(CNV)以及与身材矮小相关的印记障碍。作为联合垂体激素缺乏症一部分的许多生长激素缺乏(GHD)的新病因已被发现。孤立性GHD最常见的遗传病因是GH1和GHRHR缺陷,但最近发现了一些新病因,如GHSR、RNPC3和IFT172突变。除了明确的生长激素不敏感病因(GHR、STAT5B、IGFALS、IGF1缺陷)外,最近还发现了NFκB信号传导、STAT3和IGF2的疾病。杂合性IGF1R缺陷是产前和产后生长发育迟缓相对常见的病因。TRHA突变导致身材矮小综合征,T3/T4比值升高。各种旁分泌因子(FGFs、BMPs、WNTs、PTHrP/IHH和CNP/NPR2)的信号传导障碍或影响软骨细胞外基质的遗传缺陷通常导致不成比例的身材矮小。约3%的身材矮小儿童可能存在杂合性NPR2或SHOX缺陷,并且在没有明显综合征表现的儿童中也可能发现RAS病(如努南综合征)。许多其他与身材矮小相关的综合征是由基本细胞过程中的遗传缺陷、染色体异常、CNV和印记障碍引起的。

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