title: Noonan and cardio-facio-cutaneous syndromes: two clinically and genetically overlapping disorders.
abstract: BACKGROUND
  Noonan syndrome (NS) and cardio-facio-cutaneous syndrome (CFC) are related disorders associated with disrupted RAS/RAF/MEK/ERK signalling. NS, characterised by facial dysmorphism, congenital heart defects and short stature, is caused by mutations in the genes PTPN11, SOS1, KRAS and RAF1. CFC is distinguished from NS by the presence of ectodermal abnormalities and more severe mental retardation in addition to the NS phenotype. The genetic aetiology of CFC was recently assigned to four genes: BRAF, KRAS, MEK1 and MEK2.
  
  
  METHODS
  A comprehensive mutation analysis of BRAF, KRAS, MEK1, MEK2 and SOS1 in 31 unrelated patients without mutations in PTPN11 is presented.
  
  
  RESULTS
  Mutations were identified in seven patients with CFC (two in BRAF, one in KRAS, one in MEK1, two in MEK2 and one in SOS1). Two mutations were novel: MEK1 E203Q and MEK2 F57L. The SOS1 E433K mutation, identified in a patient diagnosed with CFC, has previously been reported in patients with NS. In one patient with NS, we also identified a mutation, BRAF K499E, that has previously been reported in patients with CFC. We thus suggest involvement of BRAF in the pathogenesis of NS also.
  
  
  CONCLUSIONS
  Taken together, our results indicate that the molecular and clinical overlap between CFC and NS is more complex than previously suggested and that the syndromes might even represent allelic disorders. Furthermore, we suggest that the diagnosis should be refined to, for example, NS-PTPN11-associated or CFC-BRAF-associated syndromes after the genetic defect has been established, as this may affect the prognosis and treatment of the patients.
authors.affiliation: Department of Genetics and Pathology, Uppsala University, SE-751 85 Uppsala, Sweden.
authors.forename: A-M
authors.initials: AM
authors.lastname: Nyström
authors.forename: S
authors.initials: S
authors.lastname: Ekvall
authors.forename: E
authors.initials: E
authors.lastname: Berglund
authors.forename: M
authors.initials: M
authors.lastname: Björkqvist
authors.forename: G
authors.initials: G
authors.lastname: Braathen
authors.forename: K
authors.initials: K
authors.lastname: Duchen
authors.forename: H
authors.initials: H
authors.lastname: Enell
authors.forename: E
authors.initials: E
authors.lastname: Holmberg
authors.forename: U
authors.initials: U
authors.lastname: Holmlund
authors.forename: M
authors.initials: M
authors.lastname: Olsson-Engman
authors.forename: G
authors.initials: G
authors.lastname: Annerén
authors.forename: M-L
authors.initials: ML
authors.lastname: Bondeson
mesh_terms: D001483:Base Sequence; D002648:Child; D002675:Child, Preschool; D019465:Craniofacial Abnormalities / Q000235:genetics* / Q000503:physiopathology; D004252:DNA Mutational Analysis; D005260:Female; D006801:Humans; D048369:MAP Kinase Kinase 1 / Q000235:genetics; D048370:MAP Kinase Kinase 2 / Q000235:genetics; D008297:Male; D009634:Noonan Syndrome / Q000235:genetics / Q000503:physiopathology; D011518:Proto-Oncogene Proteins / Q000235:genetics; D048493:Proto-Oncogene Proteins B-raf / Q000235:genetics; D016283:Proto-Oncogene Proteins p21(ras); D020837:SOS1 Protein / Q000235:genetics; D018631:ras Proteins / Q000235:genetics
chemical_list: C117307:KRAS protein, human; D011518:Proto-Oncogene Proteins; D020837:SOS1 Protein; C482128:MAP2K2 protein, human; C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf; D048369:MAP Kinase Kinase 1; D048370:MAP Kinase Kinase 2; D016283:Proto-Oncogene Proteins p21(ras); D018631:ras Proteins