Arroyo-Carrera I, Solo de Zaldivar-Tristancho M, Martin-Fernandez R, Vera-Torres M, Gonzalez de Buitrago-Amigo J F, Botet-Rodriguez J
Hospital San Pedro de Alcantara, 10003 Caceres, Espana.
Centro de Investigacion Biomedica en Red de Enfermedades Raras (CIBERER). ISCIII, Madrid, Espana.
Rev Neurol. 2016 Oct 16;63(8):358-362.
Noonan syndrome is the most frequent of the congenital group of malformation syndromes caused by germline mutations that encode components of the RAS/MAPK pathway, termed RASopathies, one of the most frequent congenital genetic disorders in the clinical practice. Recently RIT1 mutations have been reported in patients with Noonan syndrome.
A 7 years-old girl with a clinical diagnosis of Noonan syndrome, and with a hypertrophic cardiomyopathy included in her clinical manifestations, where a de novo heterozygous, probably pathogenic, novel mutation in RIT1, c.295T>C (p.Phe99Leu), has been identified.
RIT1 shares homology with other RAS proteins and the expression of mutant alleles demonstrates a gain-of-function effect supporting a causative role in Noonan syndrome pathogenesis. Data suggest that the frequency of RIT1 mutations can be estimated as 3-5% in Noonan syndrome patients. These cases compared with Noonan patients harboring mutations in other genes are characterized by high frequency of prenatal abnormalities and hypertrophic cardiomyopathy, and lower frequencies of short stature and pectus abnormalities. We emphasize the importance of the novel identified genes in order to be included in the diagnostic panels.
努南综合征是由种系突变引起的先天性畸形综合征中最常见的一种,这些突变编码RAS/丝裂原活化蛋白激酶(MAPK)信号通路的组成部分,这类疾病被称为RAS病,是临床实践中最常见的先天性遗传疾病之一。最近,已有报道在努南综合征患者中发现RIT1基因突变。
一名7岁女孩,临床诊断为努南综合征,临床表现包括肥厚型心肌病,已鉴定出其RIT1基因存在一个新发的杂合、可能致病的新型突变,即c.295T>C(p.Phe99Leu)。
RIT1与其他RAS蛋白具有同源性,突变等位基因的表达显示出功能获得效应,支持其在努南综合征发病机制中的致病作用。数据表明,在努南综合征患者中,RIT1基因突变的频率估计为3%-5%。与其他基因发生突变的努南综合征患者相比,这些病例的特点是产前异常和肥厚型心肌病的发生率较高,而身材矮小和胸壁异常的发生率较低。我们强调将新发现的基因纳入诊断指标的重要性。