背景:原发性纤毛运动障碍(PCD)是一种纤毛运动障碍,通常由常染色体隐性遗传引起,可表现为反复发作的呼吸道感染,支气管扩张,不孕症,侧向缺陷,和慢性耳鼻喉科疾病。虽然室管膜纤毛,影响中枢神经系统的脑脊液流动,在结构和功能方面与呼吸道纤毛有很多共同点,脑积水很少与PCD相关。最近,已发现叉头盒J1(FOXJ1)的变体导致PCD合并脑积水,常染色体显性遗传模式。
方法:我们进行了DNA提取,全外显子组测序(WES)分析,和FOXJ1的突变分析,并分析患者的临床和遗传数据。
结果:患者为4岁女性,生长发育正常。在3岁零2个月大的时候,患者经历了手颤抖和下肢无力。心脏超声检查显示心脏右侧,头颅磁共振成像显示梗阻性脑积水。鼻腔一氧化氮水平为54nL/min。WES表示从头,FOXJ1的杂合变体,c.734-735ins20。这个变体很新颖,不包括在人类基因突变和基因组聚集数据库中,根据美国医学遗传学和基因组学学院,导致氨基酸翻译提前终止。诊断为梗阻性脑积水后,患者接受了神经内镜下第三脑室造口术。手术后六个月,患者的运动障碍有所改善。
结论:这是第一次从头报告,FOXJ1在中国引起PCD合并脑积水的常染色体显性遗传模式。患者的临床症状与之前报道的相似。WES证实FOXJ1的新变体是PCD合并脑积水的原因,扩大与这种情况相关的基因型谱。医生应该了解脑积水和PCD的相关性,并测试FOXJ1变体。
Primary ciliary dyskinesia (PCD) is a type of ciliary dyskinesia that is usually caused by autosomal recessive inheritance and can manifest as recurrent respiratory infections, bronchiectasis, infertility, laterality defects, and chronic otolaryngological disease. Although ependymal cilia, which affect the flow of cerebrospinal fluid in the central nervous system, have much in common with respiratory cilia in terms of structure and function, hydrocephalus is rarely associated with PCD. Recently, variants of Forkhead box J1 (FOXJ1) have been found to cause PCD combined with hydrocephalus in a de novo, autosomal dominant inheritance pattern.
We performed DNA extraction, whole-exome sequencing (WES) analysis, and mutation analysis of FOXJ1 and analyzed the patient\'s clinical and genetic data.
The patient was a 4-year-old female exhibiting normal growth and development. At 3 years and 2 months of age, the patient experienced hand shaking and weakness in the lower limbs. Cardiac ultrasonography showed a right-sided heart, and cranial magnetic resonance imaging showed obstructive hydrocephalus. The nasal nitric oxide level was 54 nL/min. WES indicated a de novo, heterozygous variant of FOXJ1, c.734-735 ins20. This variant was novel, not included in the Human Gene Mutation and Genome Aggregation Database, and likely pathogenic according to the American College of Medical Genetics and Genomics, causing earlier termination of amino acid translation. The patient underwent a neuroendoscopic third ventriculostomy after the diagnosis of obstructive hydrocephalus. Six months after the operation, the patient\'s motor deficits had improved.
This is the first report of a de novo, autosomal dominant pattern of FOXJ1 causing PCD combined with hydrocephalus in China. The patient\'s clinical symptoms were similar to those previously reported. WES confirmed that a novel variant of FOXJ1 was the cause of the PCD combined with hydrocephalus, expanding the spectrum of the genotypes associated with this condition. Physicians should be aware of the correlation of hydrocephalus and PCD and test for FOXJ1 variants.