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BACKGROUND: Focal dermal hypoplasia (FDH) is rare X-linked dominant disease characterized by atrophy and linear pigmentation of the skin, split hand/foot deformities and ocular anomalies. FDH is caused by mutations of the Porcupine (PORCN) gene, which encodes an enzyme that catalyzes the palmitoylation of Wnt ligands required for their secretion. High resolution melting analysis (HRM) is a technique that allows rapid, labor-efficient, low-cost detection of genomic variants. In the present study, we report the successful implementation of HRM in the molecular diagnosis of FDH. METHODS: Polymerase chain reaction and HRM assays were designed and optimized for each of the coding exons of the PORCN gene, processing genomic DNA samples form a non-affected control and a patient complying with the FDH diagnostic criteria. The causal mutation was characterized by Sanger sequencing from an amplicon showing a HRM trace suggesting heterozygous variation and was validated using an amplification-refractory mutation system (ARMS) assay. RESULTS: The melting profiles suggested the presence of a variant in the patient within exon 1. Sanger sequencing revealed a previously unknown C to T transition replacing a glutamine codon for a premature stop codon at position 28, which was validated using ARMS. CONCLUSIONS: Next-generation sequencing facilitates the molecular diagnosis of monogenic disorders; however, its cost-benefit ratio is not optimal when a single, small or medium size causal gene is already identified and the clinical diagnostic presumption is strong. Under those conditions, as it is the case for FDH, HRM represents a cost- and labor-effective approach.

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RESUMEN Introducción: El síndrome de Goltz o hipoplasia dérmica focal es una enfermedad genética rara del grupo de las displasias ectodérmicas con un mecanismo de herencia dominante ligado al cromosoma X. Objetivo: Describir las características clínicas del síndrome de Goltz, su diagnóstico y tratamiento. Presentación del caso: Paciente femenina de 4 años de edad diagnosticada con síndrome de Goltz. Se valora en equipo multidisciplinario con las especialidades de genética, cirugía maxilofacial, estomatología, dermatología, oftalmología, ortopedia y el servicio de otorrinolaringología. Conclusiones: El síndrome de Goltz se caracteriza principalmente por afectación cutánea; anomalías oculares, dentales, faciales y esqueléticas; afectación del aparato gastrointestinal, urinario, cardiovascular y sistema nervioso central con grado variable de severidad. Su diagnóstico es clínico. La atención interdisciplinaria es fundamental para el adecuado diagnóstico y tratamiento; su pronóstico depende del grado de afectación(AU)

ABSTRACT Introduction: Goltz syndrome also known as focal dermal hypoplasia is a rare genetic disease in the ectodermal dysplasia´s group and with a mechanism of dominant inheritance linked to the X chromosome. Objectives: To describe the clinical characteristics of the Goltz syndrome, its diagnosis and treatment. Case presentation: Case of a 4 year-old female patient diagnosed with Goltz syndrome. She was studied by a multidisciplinary team including Genetics, Maxillofacial Surgery, Stomatology, Dermatology, Ophthalmology, Orthopedics and ORL specialists. Conclusions: Goltz syndrome or focal dermal hypoplasia is mainly characterized by skin affectations; eyes, dental, skeletal, and face anomalies; gastrointestinal tract, urinary, cardiovascular and central nervous systems´ affections with varying degrees of severity. The diagnosis is clinical. A multidisciplinary approach is essential for a proper diagnosis and treatment; and prognosis depends on the grade of severity(AU)

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OBJECTIVE: Focal cortical dysplasias (FCDs) are an important cause of drug-resistant epilepsy. In this work, we aimed to investigate whether abnormal gene regulation, mediated by microRNA, could be involved in FCD type II. METHODS: We used total RNA from the brain tissue of 16 patients with FCD type II and 28 controls. MicroRNA expression was initially assessed by microarray. Quantitative polymerase chain reaction, in situ hybridization, luciferase reporter assays, and deep sequencing for genes in the mTOR pathway were performed to validate and further explore our initial study. RESULTS: hsa-let-7f (p = 0.039), hsa-miR-31 (p = 0.0078), and hsa-miR34a (p = 0.021) were downregulated in FCD type II, whereas a transcription factor involved in neuronal and glial fate specification, NEUROG2 (p < 0.05), was upregulated. We also found that the RND2 gene, a NEUROG2-target, is upregulated (p < 0.001). In vitro experiments showed that hsa-miR-34a downregulates NEUROG2 by binding to its 5'-untranslated region. Moreover, we observed strong nuclear expression of NEUROG2 in balloon cells and dysmorphic neurons and found that 28.5% of our patients presented brain somatic mutations in genes of the mTOR pathway. INTERPRETATION: Our findings suggest a new molecular mechanism, in which NEUROG2 has a pivotal and central role in the pathogenesis of FCD type II. In this way, we found that the downregulation of hsa-miR-34a leads to upregulation of NEUROG2, and consequently to overexpression of the RND2 gene. These findings indicate that a faulty coupling in neuronal differentiation and migration mechanisms may explain the presence of aberrant cells and complete dyslamination in FCD type II. Ann Neurol 2018;83:623-635.

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BACKGROUND: The focal facial dermal dysplasias (FFDDs) are a group of inherited disorders of facial development, characterised by bitemporal or preauricular scar-like defects, the former resembling 'forceps marks'. Recently, different homozygous TWIST2 nonsense mutations were reported in unrelated Setleis syndrome (FFDD Type III) patients from consanguineous families, consistent with autosomal recessive inheritance. Mexican-Nahua sibs with facial and ophthalmologic features of FFDD type III were evaluated. METHODS: Genomic DNAs were isolated for sequencing of the TWIST2 gene. The clinical features and inheritance of all previously reported FFDD patients were reviewed. RESULTS: The affected sibs were homozygous for a novel TWIST2 frameshift mutation, c.168delC (p.S57AfsX45). Notably, both parents and two heterozygous sibs had distichiasis and partial absence of lower eyelashes. The FFDD subtypes were reclassified: the 'Brauer-Setleis' phenotype (autosomal dominant with variable expressivity) as FFDD type II; and patients with preauricular lesions as a new subtype, FFDD type IV. CONCLUSIONS: FFDD type III heterozygotes with TWIST2 mutations may have syndromic manifestations. Review of previous FFDD patients resulted in reclassification of the subtypes.

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La hipoplasia dérmica Focal (síndrome de Goltz) es una rara displasia ecto y mesodérmica, caracterizada por efectos cutáneos, esqueléticos, dentales, oculares y del tejido blando. Las mayor incidencia en mujeres se debe a un modo de herencia dominante ligada al X. Recientemente se detectaron mutaciones en el gen PORCN (locus Xp 11.23). Presentamos dos casos de esta entidad con revisión bibliográfica en su aspecto clínico, histopatológico, diagnostico y terapéutico.

Focal dermal hypoplasia (Goltz syndrome) is a rare mesoectodermal dysplasia characterized bydefects of the skin, skeletal system, teeth, eyes and soft tissue. The predominance of femalessuggests a form of X-linked dominant inheritance in most cases. Recently mutations in the genePORCN (locus Xp11.23)were identify in Goltz syndrome patiens.We present two cases of this entity in clinical appearance, histopathology, diagnosis andtreatment, with bibliographical review.

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Goltz syndrome is a rare genetic disease of X-linked dominant inheritance. It is more common in female patients and, in most cases, results in miscarriage of male fetuses. It has a broad scope of possible clinical manifestations. Its diagnosis consists of the sum of the many clinical, radiological and histopathological findings. The treatment options are genetic counseling, reconstructive surgery and multidisciplinary approach, aiming to improve quality of life and ensure a normal and productive life.

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A síndrome de Goltz é uma doença genética rara, de herança dominante ligada ao X, mais comum em doentes do sexo feminino e, na maioria das vezes, resulta no aborto dos fetos do sexo masculino. Tem um amplo espectro de manifestações clínicas possíveis. O diagnóstico consiste no somatório dos numerosos achados clínicos, radiológicos e histopatológicos. O tratamento é o aconselhamento genético, cirurgias reconstrutivas e abordagem multidisciplinar, com objetivo de melhorar a qualidade de vida e garantir uma vida normal e produtiva.

Goltz syndrome is a rare genetic disease of X-linked dominant inheritance. It is more common in female patients and, in most cases, results in miscarriage of male fetuses. It has a broad scope of possible clinical manifestations. Its diagnosis consists of the sum of the many clinical, radiological and histopathological findings. The treatment options are genetic counseling, reconstructive surgery and multidisciplinary approach, aiming to improve quality of life and ensure a normal and productive life.

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Focal dermal hypoplasia or Goltz syndrome is a rare congenital and mesoectodermal dysplasia with multisystemic involvement. Although the genetic alterations responsible for focal dermal hypoplasia are not fully known, there is predominance in affected females, suggesting dominant X-linked inheritance. Besides the skin, other structures frequently involved are the skeletal system, eyes, teeth, hair, and nails. Skeletal abnormalities are predominantly observed in the hands and feet. We report a 9-year-old girl who had typical linear skin atrophy on the trunk, exuberant "fat herniations," several skeletal abnormalities, and exuberant "lobster claw" deformity. In addition, she had the typical longitudinal striations in femur metaphyses. With regard to family history, her mother had one male stillbirth with several deformities. This typical focal dermal hypoplasia patient is considered valuable in light of the affected male stillbirth and parents with nonaffected phenotypes that together provides evidence for mother-to-daughter spontaneous transmission.

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A hipoplasia dérmica focal é genodermatose rara, de caráter dominante, ligada ao cromossoma X. Os autores apresentam dois casos dessa síndrome, destacando suas principais características dermatológicas e a importância da avaliação multidisciplinar em seu diagnóstico e acompanhamento

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Introducción. La hipoplasia dérmica focal o síndrome de Goltz es una displasia que afecta tejidos de origen ectodérmico y mesodérmico; muestra herencia dominante ligada al cromosoma X con latelidad in utero para los varones y en las mujeres presenta expresividad variable. Los varones afectados han correspondido a los primeros casos en la familia, por lo que se ha postulado una mutación de media cromátide en estadios tempranos de la embriogénesis con el fin de explicar el mosaico somático y germinal presente en los pacientes. Caso clínico. Se describe el caso de un varón afectado con una genodermatosis caracterizada por hipoplasia de dermis que sigue las líneas de blaschko, talla baja, microcefalia, asimetría facial, microftalmía derecha, persistencia de membrana pupilar, camptodactilia, sindactilia cutánea, hipotricosis, displasia ungueal e hipoplasia de esmalte. Se discuten los mecanismos hereditarios implicados con fines de asesoramiento genético en varones afectados. Conclusión para fines de asesoramiento genético, los riesgos para hipoplasia dérmica focal, sobre todo en casos esporádicos, deben establecerse en base a herencia dominante ligada al cromosoma X, a menos que el árbol genealógico sugiera otro patrón de transmisión hereditaria

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El síndrome de Goltz, llamado también hipoplasia dérmica focal (HDF), es un raro desorden hereditario que fue reportado primero en mujeres, descubriéndose más tarde que era letal en los varones. Este síndrome se caracteriza por hipoplasia lineal de la dermis y neoformaciones grasas, asociado con efectos oculares, dentales, esqueléticos, neurológicos, en tejidos blandos, en la piel y raramente trastornos cardiacos y renales. Se describe un paciente masculino de trece años de edad, quien es el primer caso presentado dentro de su familia

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La observación de un caso femenino de 30 años de edad, con síndrome completo de polidisplasia con hipoplasía dérmica focal y su seguimiento a través de once años, no nos permitió detectar mayores variaciones en cuanto a los signos generales de la enfermedad. Tuvimos, además, la oportunidad de estudiar a su hijo, hecho no relatado en la literatura. La pesquisa de virus en las lesiones papilomatosas fue negativa. La investigación citogenética, con técnias de bandeo C y Q, demostró la inversión del cromosoma 9 en nuestra paciente. Inmunológicamente se observó discreta disminución de los linfocitos T. Se propone seguimiento de por vida de estos enfermos a fin de confirmar la estabilidad del síndrome a través del tiempo, estudiar su descendencia y sus posibles causas de muerte

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La observación de un caso femenino de 30 años de edad, con síndrome completo de polidisplasia con hipoplasía dérmica focal y su seguimiento a través de once años, no nos permitió detectar mayores variaciones en cuanto a los signos generales de la enfermedad. Tuvimos, además, la oportunidad de estudiar a su hijo, hecho no relatado en la literatura. La pesquisa de virus en las lesiones papilomatosas fue negativa. La investigación citogenética, con técnias de bandeo C y Q, demostró la inversión del cromosoma 9 en nuestra paciente. Inmunológicamente se observó discreta disminución de los linfocitos T. Se propone seguimiento de por vida de estos enfermos a fin de confirmar la estabilidad del síndrome a través del tiempo, estudiar su descendencia y sus posibles causas de muerte (AU)

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