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Phenotype characterisation of TBX4 mutation and deletion carriers with neonatal and paediatric pulmonary hypertension

Authors :
Cecilia Surace
Csaba Galambos
Matthew J Kielt
Manish Bansal
William C. Nichols
Steven H. Abman
Nicola Ullmann
Joyce E. Johnson
Olivier Danhaive
Eric D. Austin
Joseph T. Shieh
Renato Cutrera
Mary P. Mullen
Pankaj B. Agrawal
Renata Boldrini
Donatella Peca
Nicolaus Schwerk
Matthias Griese
Michael W. Pauciulo
D. Dunbar Ivy
Cristina Haass
Irena Stucin-Gantar
Source :
European Respiratory Journal. 54:1801965
Publication Year :
2019
Publisher :
European Respiratory Society (ERS), 2019.

Abstract

Rare variants in the T-box transcription factor 4 gene (TBX4) have recently been recognised as an emerging cause of paediatric pulmonary hypertension (PH). Their pathophysiology and contribution to persistent pulmonary hypertension in neonates (PPHN) are unknown. We sought to define the spectrum of clinical manifestations and histopathology associated with TBX4 variants in neonates and children with PH.We assessed clinical data and lung tissue in 19 children with PH, including PPHN, carrying TBX4 rare variants identified by next-generation sequencing and copy number variation arrays.Variants included six 17q23 deletions encompassing the entire TBX4 locus and neighbouring genes, and 12 likely damaging mutations. 10 infants presented with neonatal hypoxic respiratory failure and PPHN, and were subsequently discharged home. PH was diagnosed later in infancy or childhood. Three children died and two required lung transplantation. Associated anomalies included patent ductus arteriosus, septal defects, foot anomalies and developmental disability, the latter with a higher prevalence in deletion carriers. Histology in seven infants showed abnormal distal lung development and pulmonary hypertensive remodelling.TBX4 mutations and 17q23 deletions underlie a new form of developmental lung disease manifesting with severe, often biphasic PH at birth and/or later in infancy and childhood, often associated with skeletal anomalies, cardiac defects, neurodevelopmental disability and other anomalies.

Details

ISSN :
13993003 and 09031936
Volume :
54
Database :
OpenAIRE
Journal :
European Respiratory Journal
Accession number :
edsair.doi...........2ab60c4f8e06bc363d1b07fe53cc5eeb
Full Text :
https://doi.org/10.1183/13993003.01965-2018