Descripción general
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La artrogriposis o artrogriposis múltiple congénita (AMC) es un grupo de afecciones no progresivas caracterizadas por múltiples contracturas articulares que se encuentran en todo el cuerpo al nacer. Suele aparecer como una característica de otras afecciones neuromusculares o como parte de enfermedades sistémicas. Los casos primarios pueden presentarse prenatalmente con disminución de los movimientos fetales asociados con contracturas articulares, así como con anomalías cerebrales, disminución de la masa muscular y polihidramnios, mientras que las causas secundarias pueden presentarse con contracturas aisladas. Los síndromes miasténicos congénitos (CMS) son un grupo de trastornos clínica y genéticamente heterogéneos que se caracterizan por una alteración de la transmisión neuromuscular. Clínicamente suelen presentarse con fatiga anormal con el esfuerzo, debilidad transitoria de los músculos extraoculares, faciales, bulbares, troncales o de las extremidades. La gravedad varía desde una debilidad leve y fásica hasta una debilidad permanente incapacitante con dificultades respiratorias y, en última instancia, la muerte. El modo de herencia de estas enfermedades sigue típicamente un patrón autosómico recesivo, aunque pueden verse formas dominantes.
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El panel de precisión de artrogriposis y síndrome miasténico congénito de Igenomix puede ser una herramienta para un diagnóstico preciso que, en última instancia, conduce a un mejor manejo y pronóstico de la enfermedad. Proporciona un análisis completo de los genes involucrados en esta enfermedad utilizando secuenciación de próxima generación (NGS) para comprender completamente el espectro de genes relevantes involucrados y su penetrancia alta o intermedia.
Indicaciones
- El panel de precisión de artrogriposis y síndrome miasténico congénito de Igenomix se utiliza para pacientes con sospecha clínica o diagnóstico con o sin los siguientes síntomas:
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⦁ Deformidades de las extremidades: compresión, ausencia de rótula, dislocación de las cabezas radiales, etc.
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⦁ Anomalías del tejido conectivo: pterigión, acortamiento, membranas, etc.
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Deformidades faciales: asimetría, puente nasal plano, hemangioma
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Deformidades de la mandíbula
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Escoliosis
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Deformidades faciales
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Hernias
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Convulsiones
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Contracturas conjuntas
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Debilidad fatigable al nacer que afecta a los músculos oculares y otros músculos craneales: músculos oculares, bulbares y de las extremidades.
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Insuficiencia respiratoria con apnea repentina
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Dificultades de alimentación
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Antecedentes familiares positivos de síndrome miasténico congénito
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Utilidad clínica
La utilidad clínica de este panel es:
- La confirmación genética y molecular para un diagnóstico clínico preciso de un paciente sintomático.
- Inicio precoz del tratamiento con la participación de un equipo multidisciplinario centrado en fisioterapia y rehabilitación intensivas, intervenciones quirúrgicas y de refuerzo y atención médica con inhibidores de la acetilcolinesterasa
- Evaluación de riesgo de familiares asintomáticos según modalidad hereditaria mediante asesoramiento genético.
- Mejora de la delimitación de la correlación genotipo-fenotipo dada la variabilidad de la gravedad y el curso de la enfermedad.
Genes y enfermedades
GENE |
OMIM DISEASES |
INHERITANCE* |
% GENE COVERAGE (20X) |
HGMD** |
ABCC8 |
Permanent |
AD,AR |
99.98 |
710 of 712 |
ACADM |
Medium Chain |
AR |
99.98 |
181 of 181 |
ACTA1 |
Congenital |
AD,AR |
100 |
224 of 224 |
ADCY6 |
Lethal |
AR |
100 |
2 of 2 |
ADGRG6 |
Lethal Congenital |
AR |
99.91 |
NA of NA |
AGRN |
Congential |
AR |
99.71 |
18 of 18 |
AIMP1 |
Hypomyelinating |
AR |
100 |
10 of 10 |
AK9 |
Postsynaptic |
– |
98.37 |
4 of 4 |
ALG14 |
Congenital |
AR |
99.99 |
7 of 7 |
ALG2 |
Congenital |
AR |
99.61 |
7 of 7 |
ALG3 |
Congenital |
AR |
99.2 |
25 of 25 |
ASCC1 |
Spinal |
AR |
99.97 |
6 of 6 |
ATAD1 |
Hereditary |
AR |
99.97 |
3 of 3 |
AUTS2 |
Autosomal |
AD |
99.63 |
9 of 17 |
BICD2 |
Autosomal |
AD |
99.94 |
39 of 39 |
BIN1 |
Autosomal |
AR |
100 |
20 of 20 |
C12ORF65 |
Combined |
AR |
na |
na |
CACNA1E |
Epileptic |
AD |
99.94 |
25 of 25 |
CASK |
Nonspherocytic |
X,XR,XD,G |
99.98 |
NA of NA |
CCDC47 |
Trichohepatoneu- |
AR |
99.94 |
5 of 5 |
CDK5 |
Lissencephaly |
AR |
100 |
5 of 5 |
CEP55 |
Multinucleated |
AR |
99.22 |
3 of 3 |
CFL2 |
Nemaline |
AR |
99.98 |
9 of 9 |
CHAT |
Congenital |
AR |
100 |
49 of 49 |
CHMP1A |
Pontocerebellar |
AR |
100 |
4 of 4 |
CHRNA1 |
Multiple |
AD,AR |
100 |
35 of 35 |
CHRNB1 |
Congential |
AD,AR |
95 |
9 of 9 |
CHRND |
Multiple |
AD,AR |
100 |
31 of 31 |
CHRNE |
Familial Infantile |
AD,AR |
99.87 |
138 of 138 |
CHRNG |
Multiple |
AR |
100 |
36 of 36 |
CHST14 |
Musculocontractural |
AR |
97.7 |
21 of 22 |
CHUK |
Cocoon |
AR |
100 |
5 of 5 |
CNTNAP1 |
Lethal Congenital |
AR |
99.97 |
25 of 25 |
COL13A1 |
Congenital |
AR |
99.97 |
16 of 16 |
COL6A2 |
Bethlem Myopathy, |
AD,AR |
100 |
223 of 225 |
COLQ |
Endplate |
AR |
100 |
70 of 71 |
DHCR24 |
Desmosterolosis |
AR |
100 |
10 of 10 |
DOK7 |
Fetal Akinesia |
AR |
99.88 |
72 of 72 |
DPAGT1 |
Congenital |
AR |
100 |
41 of 41 |
DSE |
Musculocontractural |
AR |
99.94 |
3 of 3 |
ECEL1 |
Distal |
AR |
99.52 |
39 of 39 |
EGR2 |
Demyelinating |
AD,AR |
100 |
23 of 23 |
ERBB3 |
Lethal Congenital |
AD,AR |
99.91 |
6 of 6 |
ERCC1 |
Cerebrooculofacioskeletal |
AR |
93.12 |
6 of 6 |
ERCC2 |
Cerebrooculofacioskeletal |
AR |
100 |
102 of 102 |
ERCC5 |
Cerebrooculofacioskeletal |
AR |
99.94 |
58 of 58 |
ERCC6 |
Cerebrooculofacioskeletal |
AD,AR |
99.98 |
127 of 128 |
ERGIC1 |
Neurogenic Arthrogryposis |
AR |
100 |
2 of 2 |
EXOSC3 |
Pontocerebellar |
AR |
100 |
19 of 20 |
FAM20C |
Lethal Osteosclerotic |
AR |
97.8 |
29 of 29 |
FBN2 |
Congenital Contractural |
AD |
100 |
115 of 115 |
FHL1 |
Reducing Body Myopathy, |
X,XR,XD,G |
99.98 |
NA of NA |
FIG4 |
Amyotrophic Lateral |
AD,AR |
99.92 |
72 of 72 |
FKBP10 |
Bruck Syndrome, |
AR |
100 |
51 of 51 |
FKTN |
Muscular Dystrophy- |
AR |
98 |
54 of 56 |
FLAD1 |
Lipid Storage Myopathy |
AR |
97.13 |
13 of 14 |
FLVCR2 |
Proliferative |
AR |
99.97 |
16 of 16 |
GBA |
Gaucher Disease- |
AD,AR |
100 |
469 of 471 |
GBE1 |
Glycogen Storage |
AR |
99.95 |
71 of 74 |
GCK |
Permanent Neonatal |
AD,AR |
100 |
905 of 909 |
GFM2 |
Combined Oxidative |
AR |
99.35 |
5 of 7 |
GFPT1 |
Congenital Myasthenic |
AR |
100 |
57 of 57 |
GLDN |
Lethal Congenital |
AR |
98.46 |
13 of 13 |
GLE1 |
Congenital |
AR |
100 |
17 of 17 |
GLI3 |
Greig Cephalopo- |
AD,AR |
100 |
231 of 231 |
GMPPB |
Muscular Dystrophy- |
AR |
99.95 |
53 of 53 |
HSPG2 |
Dyssegmental |
AR |
99.41 |
68 of 69 |
HYMAI |
Paternal Uniparental |
AD |
na |
na |
IBA57 |
Multiple Mitochondrial |
AR |
93.35 |
25 of 27 |
INS |
Permanent Neonatal |
AD,AR |
100 |
78 of 84 |
ITGA6 |
Epidermolysis Bullosa |
AR |
100 |
10 of 10 |
ITGB4 |
Epidermolysis Bullosa |
AD,AR |
99.12 |
115 of 115 |
KAT6B |
Genitopatellar |
AD |
99.97 |
80 of 80 |
KBTBD13 |
Childhood-Onset |
AD |
99.66 |
15 of 15 |
KCNJ11 |
Permanent Neonatal |
AD,AR |
100 |
190 of 191 |
KIAA1109 |
Alkuraya-Kucinskas |
AR |
99.95 |
21 of 21 |
KIF14 |
Meckel Syndrome, |
AR |
99.84 |
18 of 18 |
KIF1A |
Autosomal Dominant |
AD,AR |
100 |
76 of 76 |
KIF5C |
Cortical Dysplasia, |
AD |
99.96 |
7 of 7 |
KLHL40 |
Severe Congenital |
AR |
99.98 |
26 of 26 |
KLHL41 |
Childhood-Onset |
AR |
99.92 |
8 of 8 |
LAMB2 |
Pierson Syndrome |
AR |
100 |
129 of 129 |
LGI4 |
Arthrogryposis Multiplex |
AR |
99.86 |
9 of 9 |
LMNA |
Charcot-Marie-Tooth |
AD,AR |
100 |
619 of 620 |
LMOD3 |
Severe Congenital |
AR |
98.68 |
23 of 26 |
LRP4 |
Cenani-Lenz |
AD,AR |
100 |
32 of 32 |
MAGEL2 |
Prader-Willi |
AD |
99.99 |
43 of 48 |
MED13L |
Mental Retardation |
AD |
100 |
90 of 92 |
MPZ |
Axonal Type Charcot- |
AD,AR |
99.98 |
245 of 245 |
MTM1 |
Myotubular Myopathy, |
X,XR,G |
99.98 |
NA of NA |
MUSK |
Fetal Akinesia |
AR |
95.58 |
23 of 25 |
MYBPC1 |
Distal Arthrogryposis |
AD,AR |
100 |
13 of 13 |
MYH2 |
Proximal Myopathy |
AD,AR |
99.98 |
31 of 31 |
MYH3 |
Distal Arthrogryposis, |
AD,AR |
100 |
46 of 47 |
MYH8 |
Carney Complex |
AD |
100 |
6 of 6 |
MYO9A |
Congenital Myasthenic |
AR |
99.62 |
7 of 7 |
MYOD1 |
Congenital Myopathy |
AR |
99.97 |
6 of 6 |
MYPN |
Nemaline Myopathy, |
AD,AR |
99.94 |
49 of 49 |
NALCN |
Congenital Contractures |
AD,AR |
99.97 |
69 of 69 |
NEB |
Nemaline Myopathy, |
AR |
86.77 |
304 of 339 |
NEK9 |
Arthrogryposis, |
AR |
99.98 |
4 of 4 |
NUP88 |
Fetal Akinesia |
AR |
95.82 |
3 of 3 |
PDX1 |
Pancreatic Permanent |
AD,AR |
98.02 |
32 of 36 |
PHGDH |
Neu-Laxova |
AR |
100 |
26 of 26 |
PI4KA |
Polymicrogyria, |
AR |
99.76 |
4 of 4 |
PIEZO2 |
Distal Arthrogryposis, |
AD,AR |
96.93 |
37 of 37 |
PIGS |
Glycosylphospha- |
AR |
100 |
6 of 6 |
PIP5K1C |
Lethal |
AR |
99.83 |
3 of 3 |
PLAGL1 |
Paternal Uniparental |
– |
95.56 |
2 of 2 |
PLEC |
Epidermolysis |
AD,AR |
99.98 |
113 of 113 |
PLOD2 |
Bruck |
AR |
99.97 |
29 of 29 |
PLXND1 |
Moebius |
– |
98.44 |
6 of 6 |
PMM2 |
Congenital |
AR |
100 |
127 of 129 |
PPP3CA |
Arthrogryposis, |
AD |
99.98 |
16 of 16 |
PREPL |
Congenital Myasthenic |
AR |
99.92 |
7 of 12 |
PSAT1 |
Neu-Laxova Syndrome, |
AR |
99.95 |
9 of 9 |
PSMB8 |
Proteasome-Associated |
AR |
100 |
11 of 11 |
RAPSN |
Fetal Akinesia |
AR |
99.98 |
59 of 61 |
RARS2 |
Pontocerebellar |
AR |
99.98 |
39 of 40 |
REV3L |
Moebius |
|
99.08 |
7 of 7 |
RFT1 |
Congenital Disorder |
AR |
99.98 |
18 of 18 |
RIPK4 |
Popliteal Pterygium |
AR |
99.98 |
16 of 16 |
RYR1 |
Central Core Disease |
AD,AR |
97.63 |
733 of 746 |
SCN4A |
Congenital Myasthenic |
AD,AR |
99.77 |
136 of 142 |
SCO2 |
Autosomal Recessive |
AD,AR |
100 |
38 of 38 |
SELENON |
Congoenital Myopathy |
AD,AR |
89 |
NA of NA |
SHPK |
Isolated |
– |
99.96 |
2 of 2 |
SLC18A3 |
Congenital |
AR |
99.97 |
5 of 5 |
SLC25A1 |
Congenital |
AR |
90 |
23 of 25 |
SLC35A3 |
Arthrogryposis, |
AR |
99.94 |
5 of 5 |
SLC5A7 |
Congenital Myasthenic |
AD,AR |
99.92 |
21 of 21 |
SLC6A9 |
Glycine Encephalopathy |
AR |
99.99 |
5 of 5 |
SLC9A6 |
Christianson |
X,XD,G |
98.87 |
NA of NA |
SMN1 |
Spinal Muscular |
AR |
5.2 |
17 of 91 |
SMN2 |
Spinal Muscular |
AR |
7.6 |
0 of 3 |
SNAP25 |
Congenital |
AD |
100 |
6 of 6 |
SOX10 |
Peripheral Demyelinating |
AD |
99.74 |
139 of 147 |
STAC3 |
Native American |
AR |
99.98 |
5 of 5 |
STAT3 |
Multisystem Autoimmune |
AD |
100 |
171 of 171 |
STIM1 |
Immune Dysfunction |
AD,AR |
100 |
28 of 28 |
SYNE1 |
Arthrogryposis Multiplex |
AD,AR |
99.99 |
193 of 193 |
SYT2 |
Congenital |
AD |
99.98 |
4 of 4 |
TBCD |
Progressive |
AR |
94.89 |
28 of 28 |
TGFB3 |
Loeys-Dietz |
AD |
100 |
34 of 35 |
TK2 |
External |
AR |
97.08 |
64 of 65 |
TNNI2 |
Distal Arthrogryposis |
AD |
100 |
11 of 11 |
TNNT1 |
Nemaline |
AR |
89.94 |
7 of 8 |
TNNT3 |
Distal Arthrogryposis, |
AD |
99.98 |
5 of 5 |
TPM2 |
Distal Arthrogryposis, |
AD,AR |
100 |
41 of 41 |
TPM3 |
Congenital Myopathy |
AD,AR |
100 |
27 of 27 |
TRIP4 |
Congenital Muscular |
AR |
99.92 |
3 of 3 |
TRPV4 |
Brachyrachia, Familial |
AD |
100 |
88 of 88 |
TSEN2 |
Pontocerebellar |
AR |
95.47 |
4 of 5 |
TSEN54 |
Fatal Infantile |
AR |
96.94 |
20 of 22 |
UBA1 |
Infantile-Onset X- |
X,XR,G |
99.58 |
NA of NA |
VAMP1 |
Spastic Ataxia, |
AD,AR |
99.51 |
8 of 8 |
VIPAS39 |
Arthrogryposis, |
AR |
100 |
15 of 15 |
VPS33B |
Arthrogryposis, |
AR |
100 |
62 of 62 |
VRK1 |
Pontocerebellar |
AR |
99.64 |
15 of 15 |
YY1 |
Gabriele-de Vries |
AD |
99.89 |
13 of 13 |
ZBTB42 |
Lethal Congenital |
AR |
99.81 |
1 of 1 |
ZC4H2 |
Wieacker-Wolff |
X,XR,XD,G |
99.69 |
NA of NA |
ZFP57 |
Transient |
AD |
100 |
15 of 15 |
ZMPSTE24 |
Mandibuloacral |
AR |
100 |
35 of 36 |
ZNF335 |
Primary |
AR |
99.83 |
20 of 20 |
ZNHIT3 |
Peho |
AR |
73.96 |
1 of 1 |
* Herencia: AD: Autosómico Dominante; AR: autosómico recesivo; X: ligado a X; XLR: recesivo vinculado a X; Mi: mitocondrial; Mu: multifactorial; G: herencia gonosomal; D: herencia digénica
** HGMD: número de mutaciones clínicamente relevantes según HGMD
Referencias
Niles, K. M., Blaser, S., Shannon, P., & Chitayat, D. (2019). Fetal arthrogryposis multiplex congenita/fetal akinesia deformation sequence (FADS)-Aetiology, diagnosis, and management. Prenatal diagnosis, 39(9), 720–731. https://doi.org/10.1002/pd.5505
Bamshad, M., Van Heest, A. E., & Pleasure, D. (2009). Arthrogryposis: A review and update. Journal of Bone and Joint Surgery, 91(Supplement_4), 40-46. doi:10.2106/jbjs.i.00281
Ravenscroft, G., Clayton, J. S., Faiz, F., Sivadorai, P., Milnes, D., Cincotta, R., Moon, P., Kamien, B., Edwards, M., Delatycki, M., Lamont, P. J., Chan, S. H., Colley, A., Ma, A., Collins, F., Hennington, L., Zhao, T., McGillivray, G., Ghedia, S., Chao, K., … Davis, M. R. (2020). Neurogenetic fetal akinesia and arthrogryposis: genetics, expanding genotype-phenotypes and functional genomics. Journal of medical genetics, jmedgenet-2020-106901. Advance online publication. https://doi.org/10.1136/jmedgenet-2020-106901
Farmakidis, C., Pasnoor, M., Barohn, R. J., & Dimachkie, M. M. (2018). Congenital Myasthenic Syndromes: a Clinical and Treatment Approach. Current treatment options in neurology, 20(9), 36. https://doi.org/10.1007/s11940-018-0520-7
Rodríguez Cruz, P. M., Palace, J., & Beeson, D. (2018). The Neuromuscular Junction and Wide Heterogeneity of Congenital Myasthenic Syndromes. International journal of molecular sciences, 19(6), 1677. https://doi.org/10.3390/ijms19061677
Finsterer J. (2019). Congenital myasthenic syndromes. Orphanet journal of rare diseases, 14(1), 57. https://doi.org/10.1186/s13023-019-1025-5
Engel A. G. (2018). Genetic basis and phenotypic features of congenital myasthenic syndromes. Handbook of clinical neurology, 148, 565–589. https://doi.org/10.1016/B978-0-444-64076-5.00037-5
Engel A. G. (2018). Congenital Myasthenic Syndromes in 2018. Current neurology and neuroscience reports, 18(8), 46. https://doi.org/10.1007/s11910-018-0852-4
Abicht, A., Müller, J., S, & Lochmüller, H. (2003). Congenital Myasthenic Syndromes. In M. P. Adam (Eds.) et. al., GeneReviews®. University of Washington, Seattle.
Hall, J. G. (2014). Arthrogryposis (multiple congenital contractures): Diagnostic approach to etiology, classification, genetics, and general principles. European Journal of Medical Genetics, 57(8), 464-472. doi:10.1016/j.ejmg.2014.03.008