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        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p class="elsevierStyleSimplePara elsevierViewall">Los s&#237;ndromes cardiomi&#233;licos comprenden cardiopat&#237;as cong&#233;nitas y malformaciones esquel&#233;ticas de los miembros superiores&#44; y est&#225;n relacionados con mutaciones delet&#233;reas de factores de transcripci&#243;n con dominios del tipo T-Box&#46; El s&#237;ndrome de Holt-Oram se debe a una mutaci&#243;n dominante en el gen <span class="elsevierStyleItalic">TBX5</span> que altera la estructura tridimensional de la prote&#237;na impidiendo su correcta uni&#243;n al ADN&#46; Se han descrito varias mutaciones puntuales y deleciones de <span class="elsevierStyleItalic">TBX5</span> en pacientes con fenotipo de s&#237;ndrome de Holt-Oram&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">El paciente es un ni&#241;o con una comunicaci&#243;n interauricular &#40;CIA&#41; del tipo <span class="elsevierStyleItalic">ostium secundum</span> grande y una comunicaci&#243;n interventricular &#40;CIV&#41; diagnosticados por cl&#237;nica &#40;soplo&#41; y ecocardiograf&#237;a&#46; Presenta adem&#225;s unos dedos pulgares algo hipopl&#225;sicos y con un emplazamiento distal bilateral&#44; con un &#237;ndice de implantaci&#243;n de 0&#44;19 frente a una media normal de 0&#44;50 para su edad gestacional al nacer&#46; Es remitido a la consulta de Gen&#233;tica para descartar microdeleci&#243;n 22q11&#46;2&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">El cariotipo y la hibridaci&#243;n <span class="elsevierStyleItalic">in situ</span> de fluorescencia &#40;FISH&#41; con sonda D22S75 resultaron normales y debido a los hallazgos cl&#237;nicos se realiz&#243; un estudio molecular para el s&#237;ndrome de Holt-Oram&#46; Se encontr&#243; una mutaci&#243;n en el intr&#243;n 7 de <span class="elsevierStyleItalic">TBX5</span> que produce una probable alteraci&#243;n del <span class="elsevierStyleItalic">splicing</span> del gen que da lugar a una prote&#237;na truncada en su extremo C-terminal&#46; Los padres del prop&#243;sito presentan una secuencia normal para el gen&#44; lo que indica que la mutaci&#243;n se produjo <span class="elsevierStyleItalic">de novo</span>&#44; sin que pueda descartarse un mosaicismo germinal en los padres&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">El s&#237;ndrome de Holt-Oram es la causa m&#225;s frecuente de s&#237;ndrome cardiomi&#233;lico&#46; Deber&#237;a ser objeto de estudio molecular todo ni&#241;o con malformaciones card&#237;acas y alteraciones de las extremidades superiores como pulgares ausentes&#44; hipopl&#225;sicos&#44; distalmente emplazados o trifal&#225;ngicos&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p class="elsevierStyleSimplePara elsevierViewall">Cardiomyelic syndromes encompass congenital heart disease and skeletal malformations of the upper limbs and are related to mutations in transcription factors with T-Box domains&#46; Holt-Oram syndrome is caused by a dominant mutation in the <span class="elsevierStyleItalic">TBX5</span> gene that alters the three-dimensional structure of the protein and its DNA binding function&#46; Several point mutations and deletions in <span class="elsevierStyleItalic">TBX5</span> have been reported in patients with the Holt-Oram syndrome phenotype&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">The proband was a boy with a large atrial septal defect ostium secundum type and a ventricular septal defect&#44; diagnosed by clinical findings &#40;heart murmur&#41; and echocardiography&#46; He also presented slightly hypoplastic thumbs with distal bilateral placement and an implantation index of 0&#46;19 &#40;compared with an average of 0&#46;50 for his gestational age at birth&#41;&#46; The boy was referred to the department of medical genetics to rule out 22q11&#46;2 microdeletion syndrome&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">Karyotype and fluorescence <span class="elsevierStyleItalic">in situ</span> hybridization at locus D22S75 were both normal&#46; Because of his clinical findings&#44; molecular study for Holt-Oram syndrome was indicated&#44; leading to the finding of a mutation at intron 7 of <span class="elsevierStyleItalic">TBX5</span>&#44; probably producing a splicing alteration of the gene and resulting in a protein truncated at its C-terminal end&#46; The proband&#8217;s parents presented the wild type sequence of the gene&#44; thus indicating that the mutation was produced <span class="elsevierStyleItalic">de novo</span>&#44; although a possible germinal mosaicism in the parents could not be ruled out&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Holt-Oram syndrome is the most frequent cause of cardiomyelic syndrome&#46; All children with heart malformations and abnormalities of the upper limbs such as absent&#44; hypoplastic&#44; distally placed or triphalangic thumbs should undergo molecular studies for this syndrome&#46;</p>"
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Notas Clínicas
Síndrome de Holt-Oram: caracterización de una nueva mutación
Holt-oram syndrome: characterization of a novel mutation
L. Fernández García-Moyaa,
Autor para correspondencia
lfernandez.hulp@salud.madrid.org

Correspondencia: L. Fernández García-Moya. Servicio de Genética Médica. Hospital Universitario La Paz. P.° de la Castellana, 261. 28046 Madrid. España.
, P. Lapunzina Badíaa, A. Delicado Navarroa, A. Sharifb, G. Crossb, M.ªA. Mori Álvareza, M.ªL. de Torres Perezhidalgoa, M. Palomares Braloa, P. García Sánchezc, L. García-Guereta Silvad, I. López Pajaresa
a Servicio de Genética Médica. Hospital Universitario La Paz. Madrid. España
b Department of Molecular Genetics. Centre for Medical Genetics. Nottingham City Hospital. Nottingham. United Kingdom
c Servicios de. Neonatología. Hospital Universitario La Paz. Madrid. España
d Servicios de. Cardiología Infantil. Hospital Universitario La Paz. Madrid. España
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p class="elsevierStyleSimplePara elsevierViewall">Los s&#237;ndromes cardiomi&#233;licos comprenden cardiopat&#237;as cong&#233;nitas y malformaciones esquel&#233;ticas de los miembros superiores&#44; y est&#225;n relacionados con mutaciones delet&#233;reas de factores de transcripci&#243;n con dominios del tipo T-Box&#46; El s&#237;ndrome de Holt-Oram se debe a una mutaci&#243;n dominante en el gen <span class="elsevierStyleItalic">TBX5</span> que altera la estructura tridimensional de la prote&#237;na impidiendo su correcta uni&#243;n al ADN&#46; Se han descrito varias mutaciones puntuales y deleciones de <span class="elsevierStyleItalic">TBX5</span> en pacientes con fenotipo de s&#237;ndrome de Holt-Oram&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">El paciente es un ni&#241;o con una comunicaci&#243;n interauricular &#40;CIA&#41; del tipo <span class="elsevierStyleItalic">ostium secundum</span> grande y una comunicaci&#243;n interventricular &#40;CIV&#41; diagnosticados por cl&#237;nica &#40;soplo&#41; y ecocardiograf&#237;a&#46; Presenta adem&#225;s unos dedos pulgares algo hipopl&#225;sicos y con un emplazamiento distal bilateral&#44; con un &#237;ndice de implantaci&#243;n de 0&#44;19 frente a una media normal de 0&#44;50 para su edad gestacional al nacer&#46; Es remitido a la consulta de Gen&#233;tica para descartar microdeleci&#243;n 22q11&#46;2&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">El cariotipo y la hibridaci&#243;n <span class="elsevierStyleItalic">in situ</span> de fluorescencia &#40;FISH&#41; con sonda D22S75 resultaron normales y debido a los hallazgos cl&#237;nicos se realiz&#243; un estudio molecular para el s&#237;ndrome de Holt-Oram&#46; Se encontr&#243; una mutaci&#243;n en el intr&#243;n 7 de <span class="elsevierStyleItalic">TBX5</span> que produce una probable alteraci&#243;n del <span class="elsevierStyleItalic">splicing</span> del gen que da lugar a una prote&#237;na truncada en su extremo C-terminal&#46; Los padres del prop&#243;sito presentan una secuencia normal para el gen&#44; lo que indica que la mutaci&#243;n se produjo <span class="elsevierStyleItalic">de novo</span>&#44; sin que pueda descartarse un mosaicismo germinal en los padres&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">El s&#237;ndrome de Holt-Oram es la causa m&#225;s frecuente de s&#237;ndrome cardiomi&#233;lico&#46; Deber&#237;a ser objeto de estudio molecular todo ni&#241;o con malformaciones card&#237;acas y alteraciones de las extremidades superiores como pulgares ausentes&#44; hipopl&#225;sicos&#44; distalmente emplazados o trifal&#225;ngicos&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p class="elsevierStyleSimplePara elsevierViewall">Cardiomyelic syndromes encompass congenital heart disease and skeletal malformations of the upper limbs and are related to mutations in transcription factors with T-Box domains&#46; Holt-Oram syndrome is caused by a dominant mutation in the <span class="elsevierStyleItalic">TBX5</span> gene that alters the three-dimensional structure of the protein and its DNA binding function&#46; Several point mutations and deletions in <span class="elsevierStyleItalic">TBX5</span> have been reported in patients with the Holt-Oram syndrome phenotype&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">The proband was a boy with a large atrial septal defect ostium secundum type and a ventricular septal defect&#44; diagnosed by clinical findings &#40;heart murmur&#41; and echocardiography&#46; He also presented slightly hypoplastic thumbs with distal bilateral placement and an implantation index of 0&#46;19 &#40;compared with an average of 0&#46;50 for his gestational age at birth&#41;&#46; The boy was referred to the department of medical genetics to rule out 22q11&#46;2 microdeletion syndrome&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">Karyotype and fluorescence <span class="elsevierStyleItalic">in situ</span> hybridization at locus D22S75 were both normal&#46; Because of his clinical findings&#44; molecular study for Holt-Oram syndrome was indicated&#44; leading to the finding of a mutation at intron 7 of <span class="elsevierStyleItalic">TBX5</span>&#44; probably producing a splicing alteration of the gene and resulting in a protein truncated at its C-terminal end&#46; The proband&#8217;s parents presented the wild type sequence of the gene&#44; thus indicating that the mutation was produced <span class="elsevierStyleItalic">de novo</span>&#44; although a possible germinal mosaicism in the parents could not be ruled out&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Holt-Oram syndrome is the most frequent cause of cardiomyelic syndrome&#46; All children with heart malformations and abnormalities of the upper limbs such as absent&#44; hypoplastic&#44; distally placed or triphalangic thumbs should undergo molecular studies for this syndrome&#46;</p>"
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ISSN: 16954033
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