Further evidence for FGF16 truncating mutations as the cause of X-linked recessive fusion of metacarpals 4 / 5.
BACKGROUND
Metacarpal 4-5 fusion (MF4; MIM#309630) is a rare congenital malformation of the hand characterized by the partial or complete fusion of the fourth and fifth metacarpals. The anomaly occurs as an isolated trait or part of a genetic syndrome. Recently, we have identified FGF16 nonsense mutations as the underlying cause of isolated X-linked recessive MF4.


METHODS
In this report, we provide a detailed clinical description of a sporadic male patient showing MF4 in whom we performed Sanger sequencing of the entire coding sequence of FGF16.


RESULTS
In addition to MF4 symptoms, the patient presented with generalized joint laxity and hypermobility. FGF16 sequencing detected a novel truncating mutation (c.474_477del; p.E158DfsX25) in exon 3 of the gene. A heterozygous mutation was found in a clinically and radiologically unaffected mother of the proband.


CONCLUSIONS
Our finding confirms that truncating mutations of FGF16 are causative for X-linked recessive metacarpal 4-5 fusion. Importantly, the mutation detected in this study was located in last exon of the gene (exon 3), like the only two FGF16 disease-causing variants identified to date. Thus, all FGF16 mutations known to give rise to this rare skeletal hand malformation are C-terminal and most probably do not result in a nonsense mediated decay. Additionally, our proband showed mild symptoms of a connective tissue disorder, as some other patients previously reported to have X-linked MF4. Therefore, we suggest that impaired FGF16 function may also be responsible for connective tissue symptoms in MF4 patients.
Department of Medical Genetics, Poznan University of Medical Sciences, Poznan, Poland; NZOZ Center for Medical Genetics GENESIS, Poznan, Poland.
Aleksander
A
Jamsheer
Robert
R
Smigiel
Aleksandra
A
Jakubiak
Tomasz
T
Zemojtel
Magdalena
M
Socha
Peter N
PN
Robinson
Stefan
S
Mundlos
D000328:Adult; D005091:Exons / Q000235:genetics; D005260:Female; D005346:Fibroblast Growth Factors / Q000235:genetics*; D005808:Genes, Recessive; D050172:Genes, X-Linked; D040181:Genetic Diseases, X-Linked / Q000235:genetics* / Q000473:pathology; D006228:Hand Deformities, Congenital / Q000235:genetics* / Q000473:pathology; D006801:Humans; D054643:INDEL Mutation; D008297:Male; D050279:Metacarpal Bones / Q000002:abnormalities* / Q000473:pathology
C512705:FGF16 protein, human; D005346:Fibroblast Growth Factors
FGF16; MF4; X-linked inheritance; connective tissue; metacarpal 4-5 fusion; metacarpal synostosis; truncating mutation