Fetal akinesia in metatropic dysplasia: The combined phenotype of chondrodysplasia and neuropathy?

Abstract

Dominant mutations in the receptor calcium channel gene TRPV4 have been associated with a family of skeletal dysplasias (metatropic dysplasia, pseudo-Morquio type 2, spondylometaphyseal dysplasia, Kozlowski type, brachyolmia, and familial digital arthropathy) as well as with dominantly inherited neuropathies (hereditary motor and sensory neuropathy 2C, scapuloperoneal spinal muscular atrophy, and congenital distal spinal muscular atrophy). While there is phenotypic overlap between the various members of each group, the two groups were considered to be totally separate with the former being strictly a structural skeletal condition and the latter group being confined to the peripheral nervous system. We report here on fetal akinesia as the presenting feature of severe metatropic dysplasia, suggesting that certain TRPV4 mutations can cause both a skeletal and a neuropathic phenotype. Three cases were detected on prenatal ultrasound because of absent movements in the second trimester. Case 4 presented with multiple joint contractures and absent limb movements at birth and was diagnosed with "fetal akinesia syndrome". Post-interruption and post-natal X-rays showed typical features of metatropic dysplasia in all four. Sequencing of the TRPV4 gene confirmed the presence of de novo heterozygous mutations predicting G78W (Case 1), T740I (Cases 2 and 3), and K276E (Case 4). Although some degree of restriction of movements is not uncommon in fetuses with skeletal dysplasia, akinesia as leading sign is unusual and suggests that certain TRPV4 mutations produce both chondrodysplasia and a peripheral neuropathy resulting in a severe "overlap" phenotype.

• Authors: Sheila Unger, Ekkehart Lausch, Franco Stanzial, Gabriele Gillessen-Kaesbach, Irina Stefanova, Cristina Maria Di Stefano, Enrico Bertini, Carlo Dionisi-Vici, Bernd Nilius, Bernhard Zabel, Andrea Superti-Furga
• Journal: American journal of medical genetics. Part A (Am J Med Genet A) Vol. 155A Issue 11 Pg. 2860-4 (Nov 2011) ISSN: 1552-4833 [Electronic] United States
• PMID: 21964829 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2011 Wiley Periodicals, Inc.

Chemical References

• TRPV Cation Channels
• TRPV4 protein, human

Topics

• Female
• Fetal Growth Retardation (diagnosis, genetics, pathology)
• Fetus (abnormalities, pathology)
• Heterozygote
• Humans
• Infant
• Infant, Newborn
• Limb Deformities, Congenital (diagnosis, genetics, pathology)
• Male
• Muscular Atrophy, Spinal (diagnosis, genetics, pathology)
• Mutation
• Osteochondrodysplasias (diagnosis, genetics, pathology)
• Phenotype
• Pregnancy
• Pregnancy Trimester, Second
• TRPV Cation Channels (genetics)
• Ultrasonography, Prenatal