A sibling pair with cardiofaciocutaneous syndrome (CFC) secondary to BRAF mutation with unaffected parents-the first cases of gonadal mosaicism in CFC?

Am J Med Genet A. 2018 Jul;176(7):1637-1640. doi: 10.1002/ajmg.a.38725. Epub 2018 Apr 28.

Abstract

Cardiofaciocutaneous (CFC) syndrome is a RASopathy characterized by intellectual disability, congenital heart defects, a characteristic facial appearance, gastro-intestinal complications, ectodermal abnormalities and growth failure. The RASopathies result from germline mutations in the Ras/Mitogen-activated-protein-kinase (MAPK) pathway. CFC is associated with mutations in BRAF, KRAS, MEK1 and MEK2. CFC has been considered a "sporadic" disorder, with minimal recurrence risk to siblings. In recent years, vertical transmission of CFC has been seen in mutations involving the MEK2 and KRAS genes, but has not previously been reported with BRAF mutations. Two brothers with clinical features of CFC and mutations in BRAF (c.770A > G, p.Gln257Arg) are described. Neither parent (both phenotypically normal) had the BRAF mutation in their leukocyte DNA. Although this mutation is one of the most common mutations in CFC, to our knowledge, this is the first molecularly confirmed BRAF mutation causing CFC in siblings. This observation also likely represents the first description of germ cell mosaicism in CFC and so it is important to provide optimal genetic counselling to families regarding the risk of reoccurrence.

Keywords: BRAF; cardiofaciocutaneous syndrome; germ cell mosaicism; rasopathy; recurrence risk; siblings.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Ectodermal Dysplasia / genetics*
  • Ectodermal Dysplasia / pathology*
  • Facies
  • Failure to Thrive / genetics*
  • Failure to Thrive / pathology*
  • Female
  • Gonads / metabolism*
  • Gonads / pathology*
  • Heart Defects, Congenital / genetics*
  • Heart Defects, Congenital / pathology*
  • Humans
  • Infant, Newborn
  • Male
  • Mosaicism*
  • Mutation*
  • Parents
  • Phenotype
  • Proto-Oncogene Proteins B-raf / genetics*
  • Siblings

Substances

  • BRAF protein, human
  • Proto-Oncogene Proteins B-raf

Supplementary concepts

  • Cardiofaciocutaneous syndrome