title: Clinical spectrum of females with HCCS mutation: from no clinical signs to a neonatal lethal form of the microphthalmia with linear skin defects (MLS) syndrome.
abstract: BACKGROUND
  Segmental Xp22.2 monosomy or a heterozygous HCCS mutation is associated with the microphthalmia with linear skin defects (MLS) or MIDAS (microphthalmia, dermal aplasia, and sclerocornea) syndrome, an X-linked disorder with male lethality. HCCS encodes the holocytochrome c-type synthase involved in mitochondrial oxidative phosphorylation (OXPHOS) and programmed cell death.
  
  
  METHODS
  We characterized the X-chromosomal abnormality encompassing HCCS or an intragenic mutation in this gene in six new female patients with an MLS phenotype by cytogenetic analysis, fluorescence in situ hybridization, sequencing, and quantitative real-time PCR. The X chromosome inactivation (XCI) pattern was determined and clinical data of the patients were reviewed.
  
  
  RESULTS
  Two terminal Xp deletions of ≥ 11.2 Mb, two submicroscopic copy number losses, one of ~850 kb and one of ≥ 3 Mb, all covering HCCS, 1 nonsense, and one mosaic 2-bp deletion in HCCS are reported. All females had a completely (>98:2) or slightly skewed (82:18) XCI pattern. The most consistent clinical features were microphthalmia/anophthalmia and sclerocornea/corneal opacity in all patients and congenital linear skin defects in 4/6. Additional manifestations included various ocular anomalies, cardiac defects, brain imaging abnormalities, microcephaly, postnatal growth retardation, and facial dysmorphism. However, no obvious clinical sign was observed in three female carriers who were relatives of one patient.
  
  
  CONCLUSIONS
  Our findings showed a wide phenotypic spectrum ranging from asymptomatic females with an HCCS mutation to patients with a neonatal lethal MLS form. Somatic mosaicism and the different ability of embryonic cells to cope with an OXPHOS defect and/or enhanced cell death upon HCCS deficiency likely underlie the great variability in phenotypes.
authors.forename: Vanessa A
authors.initials: VA
authors.lastname: van Rahden
authors.forename: Isabella
authors.initials: I
authors.lastname: Rau
authors.forename: Sigrid
authors.initials: S
authors.lastname: Fuchs
authors.forename: Friederike K
authors.initials: FK
authors.lastname: Kosyna
authors.forename: Hiram Larangeira
authors.initials: HL
authors.lastname: de Almeida
authors.forename: Helen
authors.initials: H
authors.lastname: Fryssira
authors.forename: Bertrand
authors.initials: B
authors.lastname: Isidor
authors.forename: Anna
authors.initials: A
authors.lastname: Jauch
authors.forename: Madeleine
authors.initials: M
authors.lastname: Joubert
authors.forename: Augusta M A
authors.initials: AM
authors.lastname: Lachmeijer
authors.forename: Christiane
authors.initials: C
authors.lastname: Zweier
authors.forename: Ute
authors.initials: U
authors.lastname: Moog
authors.affiliation: Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany. kkutsche@uke.de.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Kutsche
mesh_terms: D002648:Child; D002675:Child, Preschool; D041321:Chromosomes, Human, X / Q000235:genetics; D005260:Female; D040181:Genetic Diseases, X-Linked / Q000235:genetics / Q000473:pathology*; D006801:Humans; D007223:Infant; D008850:Microphthalmos / Q000235:genetics / Q000473:pathology*; D012867:Skin / Q000473:pathology*; D012868:Skin Abnormalities / Q000235:genetics / Q000473:pathology*; D049951:X Chromosome Inactivation / Q000235:genetics
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