title: Hand and fibrillin-1 deposition abnormalities in Loeys-Dietz syndrome--expanding the clinical spectrum.
abstract: Loeys-Dietz syndrome (LDS) is an autosomal dominant connective tissue disorder characterized by hypertelorism, bifid uvula, cleft palate and arterial tortuosity. We report on a patient with LDS, bearing mutation in the TGFβR2 gene, whose prenatal examination demonstrated clenched fists and club feet, suggesting arthrogryposis multiplex congenita. Postnatal assessment showed digital abnormalities, including brachydactyly, camptodactyly, partial syndactyly and absent distal phalanges. With the lack of fibrillin-1 microfibril deposition as well as impaired and inadequate elastic fiber assembly in our patient's fibroblasts, we speculate that the skeletal abnormalities seen in this patient with LDS are the result of lack of these components in embryonal perichondrium and in blood vessels. We suggest that LDS should be included in the differential diagnosis of joint contractures seen pre and postnatally. Prenatal diagnosis of LDS would be important in parental counseling and early post natal diagnosis could prompt treatment before the development of detrimental vascular complications.
authors.affiliation: Department of Paediatrics and Adolescent Medicine, Centre for Reproduction, Growth and Development, The University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: Brian H Y
authors.initials: BH
authors.lastname: Chung
authors.forename: Tim
authors.initials: T
authors.lastname: Bradley
authors.forename: Lars
authors.initials: L
authors.lastname: Grosse-Wortmann
authors.forename: Susan
authors.initials: S
authors.lastname: Blaser
authors.forename: Peter
authors.initials: P
authors.lastname: Dirks
authors.forename: Aleksander
authors.initials: A
authors.lastname: Hinek
authors.forename: David
authors.initials: D
authors.lastname: Chitayat
mesh_terms: D000015:Abnormalities, Multiple; D002478:Cells, Cultured; D004252:DNA Mutational Analysis; D020405:Dermis / Q000166:cytology / Q000378:metabolism; D000071838:Fibrillin-1; D000071837:Fibrillins; D005347:Fibroblasts / Q000378:metabolism; D006228:Hand Deformities, Congenital; D006801:Humans; D007231:Infant, Newborn; D055947:Loeys-Dietz Syndrome / Q000175:diagnosis* / Q000235:genetics / Q000378:metabolism*; D008297:Male; D008840:Microfilament Proteins / Q000378:metabolism*; D010641:Phenotype; D011296:Prenatal Diagnosis; D017346:Protein Serine-Threonine Kinases / Q000235:genetics; D000077294:Receptor, Transforming Growth Factor-beta Type II; D018125:Receptors, Transforming Growth Factor beta / Q000235:genetics; D054392:Adipokines
chemical_list: D000071838:Fibrillin-1; D000071837:Fibrillins; D008840:Microfilament Proteins; D017346:Protein Serine-Threonine Kinases; D000077294:Receptor, Transforming Growth Factor-beta Type II; D018125:Receptors, Transforming Growth Factor beta; C000605722:FBN1 protein, human; D054392:Adipokines
keywords: Loeys-Dietz syndrome; arthrogryposis multiplex congenita; club feet; hand malformations; skeletal abnormalities