Brenner R E, Nerlich A, Kirchner F, Mörike M, Terinde R, Teller W M
Department of Pediatrics, University of Ulm, Germany.
Am J Med Genet. 1993 Jun 15;46(5):584-91. doi: 10.1002/ajmg.1320460525.
We report on a case of lethal short-limbed skeletal dysplasia with extremely short ribs, median cleft upper lip and palate, malrotation of intestine, lung hypoplasia with bilateral segmentation defect, atrial septum defect, union of distal urethra and vagina, and complex brain malformations. Based on radiological criteria and the pattern of associated abnormalities a short rib syndrome without polydactyly (Type Beemer) was diagnosed. Morphologically, the growth plate showed a reduced proliferation zone and an enlarged zone of hypertrophic cartilage. In addition, islands of persistent hypertrophic cartilage were present even in the metaphysis. In monolayer cell cultures supplemented with 10% fetal calf serum proliferation was normal in articular chondrocytes, reduced in costal chondrocytes, and elevated in osteoblasts from the patient. Clonal growth of costal and articular chondrocytes in methylcellulose could be stimulated normally by insulin-like growth factor-I (IGF-I), IGF-II, and human growth hormone (hGH). However, the response to transforming growth factor beta 1 (TGF-beta 1) was markedly elevated in articular chondrocytes of the patient compared to those of 3 fetal controls. Quantitative collagen synthesis in both osteoblasts and chondrocytes from the patient did not differ significantly from that of controls. Osteoblasts synthesized predominantly collagen I and minor amounts of collagen III, chondrocytes synthesized primarily collagen II. All collagen chains including CNBr-peptides of collagen II showed normal migration in PAA gel electrophoresis.
我们报告了一例致死性短肢骨骼发育不良病例,伴有极短肋骨、唇腭裂、肠道旋转不良、双侧肺叶发育不全合并节段性缺损、房间隔缺损、尿道远端与阴道融合以及复杂脑畸形。根据放射学标准和相关异常模式,诊断为无多指畸形的短肋综合征(比默型)。形态学上,生长板显示增殖区减少,肥大软骨区扩大。此外,甚至在干骺端也存在持续肥大软骨岛。在添加10%胎牛血清的单层细胞培养中,患者的关节软骨细胞增殖正常,肋软骨细胞增殖减少,成骨细胞增殖增加。胰岛素样生长因子-I(IGF-I)、IGF-II和人生长激素(hGH)可正常刺激肋软骨细胞和关节软骨细胞在甲基纤维素中的克隆生长。然而,与3个胎儿对照相比,患者关节软骨细胞对转化生长因子β1(TGF-β1)的反应明显升高。患者成骨细胞和软骨细胞中的胶原定量合成与对照相比无显著差异。成骨细胞主要合成I型胶原和少量III型胶原,软骨细胞主要合成II型胶原。所有胶原链包括II型胶原的CNBr肽段在聚丙烯酰胺凝胶电泳中均显示正常迁移。