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Combined mutation screening of NKX2-5, GATA4, and TBX5 in congenital heart disease: multiple heterozygosity and novel mutations.
[holt-oram syndrome]
Background
.
 
Variants
of
several
genes
encoding
transcription
modulators
,
signal
transduction
,
and
structural
proteins
are
known
to
cause
Mendelian
congenital
heart
disease
(
CHD
)
.
NKX
2
-
5
and
GATA
4
were
the
first
CHD-causing
genes
identified
by
linkage
analysis
in
large
affected
families
.
Mutations
of
TBX
5
cause
Holt-
Oram
syndrome
,
which
includes
CHD
as
a
clinical
feature
.
All
three
genes
have
a
well-established
role
in
cardiac
development
.
Design
.
 
In
order
to
investigate
the
possible
role
of
multiple
mutations
in
CHD
,
a
combined
mutation
screening
was
performed
in
NKX
2
-
5
,
GATA
4
,
and
TBX
5
in
the
same
patient
cohort
.
Samples
from
a
cohort
of
331
CHD
patients
were
analyzed
by
polymerase
chain
reaction
,
double
high
-performance
liquid
chromatography
and
sequencing
in
order
to
identify
changes
in
the
NKX
2
-
5
,
GATA
4
,
and
TBX
5
genes
.
Results
.
 
Two
cases
of
multiple
heterozygosity
of
putative
disease-causing
mutations
were
identified
.
One
patient
was
found
with
a
novel
L
122
P
NKX
2
-
5
mutation
in
combination
with
the
private
A
1443
D
mutation
of
MYH
6
.
A
patient
heterozygote
for
a
D
425
N
GATA
4
mutation
carries
also
a
private
mutation
of
the
MYH
6
gene
(
V
700
M
)
.
Conclusions
.
 
In
addition
to
reporting
two
novel
mutations
of
NKX
2
-
5
in
CHD
,
we
describe
families
where
multiple
individual
mutations
seem
to
have
an
additive
effect
over
the
pathogenesis
of
CHD
.
Our
findings
highlight
the
usefulness
of
multiple
gene
mutational
analysis
of
large
CHD
cohorts
.
Diseases
Validation
Diseases presenting
"heart disease"
symptom
22q11.2 deletion syndrome
achondroplasia
acute rheumatic fever
adrenal incidentaloma
child syndrome
classical phenylketonuria
cohen syndrome
congenital diaphragmatic hernia
dentinogenesis imperfecta
esophageal adenocarcinoma
fabry disease
familial mediterranean fever
heparin-induced thrombocytopenia
hirschsprung disease
holt-oram syndrome
homocystinuria without methylmalonic aciduria
kabuki syndrome
monosomy 21
omenn syndrome
phenylketonuria
sneddon syndrome
systemic capillary leak syndrome
wiskott-aldrich syndrome
wolf-hirschhorn syndrome
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