Perfil de habilidades do desenvolvimento em crianças com holoprosencefalia e holoprosencefalia like

OBJETIVO: investigar e comparar o desempenho nas habilidades relacionadas ao desenvolvimento motor, cognitivo, linguístico, de socialização e autocuidados de indivíduos com holoprosencefalia e com holoprosencefalia-like. MÉTODO: participaram deste estudo 20 indivíduos com diagnóstico de holoprosencefalia, na faixa etária de 18 a 72 meses, de ambos os sexos, divididos em 2 grupos. O grupo 1 (G1) composto por 12 indivíduos com sinais clínicos do espectro da holoprosencefalia, e o grupo 2 (G2) com holoprosencefalia-like composto por 8 indivíduos com sinais clínicos do espectro da holoprosencefalia-like. A coleta de dados foi realizada por meio da aplicação do Inventário Portage Operacionalizado que avalia as áreas alvos deste estudo. Para a análise estatística utilizou-se análise descritiva da mediana e dos valores mínimos e máximos e foi aplicado o teste estatístico de Mann Whitney (< 0,05% para significância). RESULTADOS: os grupos 1 e 2 apresentaram alterações em todas as áreas do desenvolvimento avaliadas. Entretanto, os indivíduos do G1, com holoprosencefalia apresentaram maiores comprometimentos nas habilidades: motora, cognitiva, de linguagem, de socialização e autocuidados, quanto comparados aos indivíduos do G2, com holoprosencefalia-like. CONCLUSÃO: o desempenho nas áreas motoras, cognitivas, de linguagem, de socialização e autocuidados de indivíduos com holoprosencefalia e holoprosencefalia-like foi aquém do esperado, principalmente naqueles indivíduos com holoprosencefalia, que se justifica pelo maior comprometimento no sistema nervoso central. A natureza destas alterações pode estar associada ao universo de alterações neurológicas e craniofaciais descritas nestes quadros clínicos e também à influência do ambiente social.

Processamento auditivo, leitura e escrita na síndrome de Silver-Russell: relato de caso

O objetivo deste trabalho foi descrever os aspectos fonoaudiológicos de processamento auditivo, leitura e escrita de um paciente do gênero masculino com diagnóstico de síndrome de Silver-Russell. Aos dois meses de idade o paciente apresentava déficit pôndero-estatural; frontal amplo; orelhas pequenas, proeminentes e com baixa implantação; palato ogival; discreta micrognatia; esclera azulada; manchas café-com-leite; sobreposição do primeiro e segundo artelhos à direita; refluxo gastroesofágico; voz e choro agudos; atraso leve no desenvolvimento neuropsicomotor; e dificuldade de ganhar peso, recebendo o diagnóstico da síndrome. Na avaliação psicológica, realizada aos 8 anos de idade, o paciente apresentou nível intelectual normal, com dificuldades cognitivas envolvendo atenção sustentada, concentração, memória verbal imediata e processos emocionais e comportamentais. Para avaliação da leitura e escrita e de seus processos subjacentes, realizada aos 9 anos de idade foram utilizados os testes de Compreensão Leitora de Textos Expositivos, Perfil das Habilidades Fonológicas, Teste de Discriminação Auditiva, escrita espontânea, Teste de Desempenho Escolar (TDE), teste de Nomeação Automática Rápida e prova de memória de trabalho fonológica. Apresentou dificuldades em todos os testes, estando as pontuações abaixo do esperado para sua idade. Na avaliação do processamento auditivo foram realizados testes monóticos, dióticos e dicóticos. Foram encontradas alterações nas habilidades de atenção auditiva sustentada e seletiva, memória sequencial para sons verbais e não-verbais, e resolução temporal. Conclui-se que o paciente apresenta alterações na aprendizagem da leitura e escrita que podem ser secundários a síndrome de Silver-Russell, porém tais dificuldades também podem ser decorrentes das alterações em habilidades do processamento auditivo.

Idade e indicações de osteotomias para avanço frontofacial em pacientes com craniossinostoses sindrômicas

INTRODUÇÃO: Desde o início da Cirurgia Craniofacial, muitos desafios foram ultrapassados. Problemas operatórios técnicos e de infraestrutura básica de atendimento especializado foram solucionados. Agora, 25 anos após as publicações iniciais dos avanços frontofaciais, há ainda algumas dúvidas quanto às indicações precisas da idade e do tipo de cirurgia a ser realizada. O objetivo deste estudo foi avaliar a evolução de pacientes submetidos a tratamento de craniossinostoses sindrômicas operados nos últimos 10 anos em nossa instituição. MÉTODO: Todos os pacientes sindrômicos submetidos a avanço frontofacial em monobloco ou somente facial isolado foram selecionados no período de 2001 a 2011. Foram selecionados 70 pacientes, 56 submetidos a avanço frontofacial em monobloco e 14, a avanço facial após remodelagem frontorbitária prévia. Todos os dados referentes a esses pacientes foram correlacionados, avaliando a idade e o resultado final. Os pacientes foram selecionados de acordo com idade à época da cirurgia, complicações existentes e resultados finais correlacionados com os principais problemas existentes previamente. RESULTADOS: Os pacientes sindrômicos apresentaram graus variados de resultados finais, dependendo da síndrome e da idade de realização do procedimento. Os avanços frontofaciais em monobloco apresentaram baixo índice de complicações pós-operatórias imediatas, porém ficou demonstrada a necessidade de procedimentos futuros ao final do crescimento facial. Nos pacientes submetidos a cirurgias mais tardiamente, o índice de resultados positivos foi maior. CONCLUSÕES: Nos casos de craniossinostoses graves, com problemas funcionais, a indicação de avanço frontofacial em monobloco continua sendo a melhor opção terapêutica.

The influence of asthma onset and severity on malocclusion prevalence in children and adolescents

OBJECTIVE: The influence of asthma, its severity levels and onset time on malocclusion occurrence were investigated. METHODS: The sample was composed by 176 children/adolescents, of both genders, aged 3 to 15 years, that were divided in two groups. The asthma group (AG) enrolled 88 children/adolescents that were seen at the Breathe Londrina Program. The asthma-free group (AFG) enrolled 88 preschool and school children recruited in 2 public schools. Malocclusion diagnosis was made according to WHO criteria (OMS, 1999). RESULTS: A higher prevalence in malocclusions in asthmatic patients in mixed dentition was observed when compared to controls (p<0.05). On the other hand, these results were not observed for deciduous (p>0.05) and permanent dentition (p>0.05). A significant association was seen between asthma onset time and marked maxillary overjet (p<0.05), and open bite (p<0.05) in the mixed dentition, being both conditions more common among those that have presented the symptoms of asthma prior to 12 months of age. CONCLUSION: The results of this study indicate that the early manifestation of asthma at first year of life can cause dentofacial changes. Therefore, the prompt diagnostic of the illness, as well as the establishment of a proper therapy could improve the symptoms and chronic complications of asthma and also reduce its impact on craniofacial development.

Photometric analysis applied in determining facial type

INTRODUCTION: In orthodontics, determining the facial type is a key element in the prescription of a correct diagnosis. In the early days of our specialty, observation and measurement of craniofacial structures were done directly on the face, in photographs or plaster casts. With the development of radiographic methods, cephalometric analysis replaced the direct facial analysis. Seeking to validate the analysis of facial soft tissues, this work compares two different methods used to determining the facial types, the anthropometric and the cephalometric methods. METHODS: The sample consisted of sixty-four Brazilian individuals, adults, Caucasian, of both genders, who agreed to participate in this research. All individuals had lateral cephalograms and facial frontal photographs. The facial types were determined by the Vert Index (cephalometric) and the Facial Index (photographs). RESULTS: The agreement analysis (Kappa), made for both types of analysis, found an agreement of 76.5%. CONCLUSIONS: We concluded that the Facial Index can be used as an adjunct to orthodontic diagnosis, or as an alternative method for pre-selection of a sample, avoiding that research subjects have to undergo unnecessary tests.

Anti-parasitic and anti-viral immune responses in insects

Insects encounter many microorganisms in nature and to survive they have developed counter measures against the invading pathogens. In Drosophila melanogaster research on insect immunity has mainly been focused on infections by bacteria and fungi. We have explored the immune response against natural infections of the parasite Octosporea muscaedomesticae and the Drosophila C virus as compared to natural infections of bacteria and fungi. By using Affymetrix Drosophila GeneChips, we were able to obtain 48 genes uniquely induced after parasitic infection. It was also clearly shown that natural infections led to different results than when injecting the pathogens. In order to search for the ultimate role of the lepidopteran protein hemolin, we used RNA interference (RNAi). We could show that injection of double stranded RNA (dsRNA) of Hemolin in pupae of Hyalophora cecropia led to embryonic malformation and lethality and that there was a sex specific difference. We continued the RNAi investigation of hemolin in another lepidopteran species, Antheraea pernyi, and discovered that hemolin was induced by dsRNA per se. A similar induction of hemolin was seen after infection with baculovirus and we therefore performed in vivo experiments on baculovirus infected pupae. We could show that a low dose of dsHemolin prolonged the period before the A. pernyi pupae showed any symptoms of infection, while a high dose led to a more rapid onset of symptoms. By performing in silico analysis of the hemolin sequence from A. pernyi in comparison with other Hemolin sequences, it was possible to select a number of sites that either by being strongly conserved or variable could be important targets for future studies of hemolin function.

Development of skeletal deformities in Gilthead sea bream (Sparus aurata) reared under different larval culture and dietary conditions

[EN] Main deformities such as lordosis, opercular deformities and upper/lower jaws shortening are considered as quality descriptors in commercial marine fish fry production and seem to be related at least with larval culture conditions in early larval stages. The aim of this work was to obtain information about the contribution of the diet and rearing system to the apparition of these abnormalities in gilthead sea bream (Sparus aurata) larvae in semi-industrial scale facilities. For that purpose, two different larval rearing systems semi-intensive and intensive were compared by duplicate and with the same live feed enrichments; besides, two different rotifer enrichments were tested in an intensive system. Biochemical composition of larvae, preys and commercial products was analysed. At 50 days post hatching six hundred fish per treatment were individually studied under stereoscope and abnormalities frequency recorded. At 95 days post hatching fry were soft X ray monitored as well. Survival and malformation frequency were significantly different between treatments, the effect of diet and system are discussed. A significantly lower percentage of deformity rates together with better survival and growth were obtained in the semi-intensive system, whereas the rotifer enrichment significantly affected larval survival.

Accuratezza nella diagnosi prenatale di malformazione fetale

OBJECTIVE: One major problem in counselling couples with a prenatal diagnosis of a correctable fetal anomaly is the ability to exclude associated malformations that may modify the prognosis. Our aim was to assess the precision of fetal sonography in identifying isolated malformations. METHODS: We retrospectively reviewed the prenatal and postnatal records of our center for cases with a prenatal diagnosis of an isolated fetal anomaly in the period 2002-2007. RESULTS: The antenatal diagnosis of an isolated malformation was made in 284 cases. In one of this cases the anomaly disappeared in utero. Of the remaining cases, the prenatal diagnosis was confirmed after birth in 251 (88.7%). In 8 fetuses (7 with a suspected coarctation of the aorta, 1 with ventricular septal defect) the prenatal diagnosis was not confirmed. In 24 fetuses (8.5%) additional malformations were detected at postnatal or post-mortem. In 16 of these cases the anomalies were mild or would not have changed the prognosis. In 8 cases (2.8%) severe anomalies were present (1 hypoplasia of the corpus callosum with ventriculomegaly, 1 tracheal agenesis, 3 cases with multiple anomalies, 1 Opitz Syndrome, 1 with CHARGE Syndrome, 1 COFS Syndrome). Two of these infants died. CONCLUSIONS: the prenatal diagnosis of an isolated fetal anomaly is highly reliable. However, the probability that additional malformations will go undetected albeit small remains tangible. In our experience, it was 2.8%.

Il craniofaringioma nel bambino e nell'adolescente. Luci ed ombre durante il follow-up

Introduction. Craniopharyngioma (CF) is a malformation of the hypothalamicpituitary region and it is the most common nonglial cerebral tumor in children with an high overall survival rate. In some case severe endocrinologic and metabolic sequelae may occur during follow up. 50% of patients (pts), in particular those with radical removal of suprasellar lesions, develop intractable hyperphagia and morbid obesity, with dyslypidemia and high cardiovascular risk. We studied the auxological and metabolic features of a series of 29 patients (18 males) treated at a mean age of 7,6 years, followed up in our Centre from 1973 to 2008 with a mean follow up of 8,3 years. Patients features at the onset. 62% of pts showed as first symptoms of disease visual impairment and neurological disturbancies (headache); 34% growth arrest; 24% signs of raised intracranial pressure and 7% diabetes insipidus. Diagnosis. Diagnosis of CF was reached finally by TC or MRI scans which showed endo-suprasellar lesion in 23 cases and endosellar tumour in 6 cases. Treatment and outcome. 25/29 pts underwent surgical removal of CF (19 by transcranial approach and 6 by endoscopic surgery); 4 pts underwent stereotactic surgery as first line therapy. 3 pts underwent local irradiation with yttrium-90, 5 pts post surgery radiotherapy. 45% of pts needed more than one treatment procedure. Results. After CF treatment all patients suffered from 3 or more pituitary hormone deficiencies and diabetes insipidus. They underwent promptly substitutive therapy with corticosteroids, l-thyroxine and desmopressin. In 28/29 pts we found growth hormone (GH) deficiency. 20/28 pts started GH substitutive therapy and 15 pts reached final height(FH) near target height(TH). 8 pts were not GH treated for good growth velocity, even without GH, or for tumour residual. They reached in 2 cases FH over TH showing the already known phenomenon of growth without GH. 38% of patients showed BMI SDS >2 SDS at last assessment, in particular pts not GH treated (BMI 2,5 SDS) are more obese than GH treated (BMI 1,2 SDS). Lipid panel of 16 examined pts showed significative differencies among GH treated (9 pts) and not treated (7 pts) with better profile in GH treated ones for Total Cholesterol/C-HDL and C-LDL/C-HDL. We examined intima media thickness of common carotid arteries in 11 pts. 3/4 not GH treated pts showed ultrasonographic abnormalities: calcifications in 2 and plaque in 1 case. Of them 1 pt was only 12,6 years old and already showed hypothalamic obesity with hyperphagia, high HOMA index and dyslipidemia. In the GH treated group (7) we found calcifications in 1 case and a plaque in another one. GH therapy was started in the young pt with carotid calcifications, with good improvement within 6 months of treatment. 5/29 pts showed hypothalamic obesity, related to hypothalamic damage (type of surgical treatment, endo-suprasellar primitive lesion, recurrences). 48% of patients recurred during follow up ( mean time from treatment: 3 years) and underwent, in some cases up to 4 transcranial surgical treatments. GH seems not to increase recurrence rate since 40% of GH treated recurred vs 66,6% of not GH treated pts. Discussion. Our data show the extereme difficulties that occur during follow up of craniopharyngioma treated patients. GH therapy should be offered to all patients even with good growth velocity after CF treatment, to avoid dislypidemia and reduce cardiovascular risk. The optimal therapy is not completely understood and whether gross tumor removal or partial surgery is the best option remains to be decided only on one patient tumour features and hypothalamic involvement. In conclusion the gold standard treatment of CF remains complete tumour removal, when feasible, or partial resection to preserve hypothalamic function in endosuprasellar large neoplasms.

Sindrome di Down e fattori di rischio nel declino neurocognitivo

Down syndrome (DS) or Trisomy 21, occurring in 1/700 and 1/1000 livebirths, is the most common genetic disorder, characterized by a third copy of the human chromosome 21 (Hsa21). DS is associated with various defects, including congenital heart diseases, craniofacial abnormalities, immune system dysfunction, mental retardation (MR), learning and memory deficiency. The phenotypic features in DS are a direct consequence of overexpression of genes located within the triplicated region on Hsa21. In addition to developmental brain abnormalities and disabilities, people with DS by the age of 30-40 have a greatly increased risk of early-onset of Alzheimer’s disease (AD) and an apparent tendency toward premature aging. Many of the immunological anomalies in DS can be enclosed in the spectrum of multiple signs of early senescence. People with DS have an increased vulnerability to oxidative damage and many factors, including amyloid beta protein (Abeta), genotype ApoE4, oxidative stress, mutations in mitochondrial DNA (mtDNA), impairment of antioxidant enzymes, accelerated neuronal cell apoptosis, are related to neuronal degeneration and early aging in DS. SUBJECTS and METHODS: Since 2007 a population of 50 adolescents and adults with DS, 26 males and 24 females (sex-ratio: M/F = 1.08), has been evaluated for the presence of neurological features, biomarkers and genetic factors correlated with neuronal degeneration and premature aging. The control group was determined by the mother and the siblings of the patients. A neuropsychiatric evaluation was obtained from all patients. The levels of thyroid antibodies (antiTg and antiTPO) and of some biochemical markers of oxidative stress, including homocysteine (tHcy), uric acid, cobalamin, folate were measured. All patients, the mother and the siblings were genotyped for ApoE gene. RESULTS: 40% of patients, with a mild prevalence of females aged between 19 and 30 years, showed increased levels of antiTg and antiTPO. The levels of tHcy were normal in 52% patients and mildly increased in 40%; hyperomocysteinemia was associated with normal levels of thyroid antibodies in 75% of patients (p<0.005). The levels of uric acid were elevated in 26%. Our study showed a prevalence of severe MR in patients aged between 1-18 years and over 30 years. Only 3 patients, 2 females and one male, over 30 years of age, showed dementia. According to the literature, the rate of Down left-handers was high (25%) compared to the rest of population and the laterality was associated with increased levels of thyroid antibodies (70%). 21.5% of patients were ApoE4 positive (ApoE4+) with a mean/severe MR. CONCLUSIONS: Until now no biochemical evidence of oxidative damage and no deficiency or alteration of antioxidant function in our patients with DS were found. mtDNA sequencing could show some mutations age-related and associated with oxidative damage and neurocognitive decline in the early aging of DS. The final aim is found predictive markers of early-onset dementia and a target strategy for the prevention and the treatment of diseases caused by oxidative stress. REFERENCES: 1) Rachidi M, Lopes C: “Mental retardation and associated neurological dysfunctions in Down syndrome: a consequence of dysregulation in critical chromosome 21 genes and associated molecular pathways.” - Eur J Paediatr Neurol. May;12(3):168-82 (2008). 2) Lott IT, Head E: “Down syndrome and Alzheimer's disease: a link between development and aging.” - Ment Retard Dev Disabil Res Rev, 7(3):172-8 (2001). 3) Lee HC, Wei YH: “Oxidative Stress, Mitochondrial DNA Mutation, and Apoptosis in Aging.” - Exp Biol Med (Maywood), May;232(5):592-606 (2007).

Molekulare Untersuchung des Wolf-Hirschhorn-Syndroms

Das Wolf-Hirschhorn-Syndrom (WHS) ist ein komplexes und variables Fehlbildungs- Retardierungssyndrom, das durch Deletion in der distalen Chromosomenregion 4p16.3 hervorgerufen wird und dessen Ätiologie und Pathogenese bisher weitgehend unverstanden sind. Die Zielsetzung in der vorliegenden Arbeit bestand in der Identifizierung und vorläufigen Charakterisierung neuer Gene, die an der Entstehung des Syndroms beteiligt sein könnten. Die Wolf-Hirschhorn-Syndrom-kritische Region (WHSCR) konnte zu Beginn der vorliegenden Arbeit auf einen ca. 2 Mb großen Bereich zwischen den Markern D4S43 und D4S142 eingegrenzt werden. Für die Identifizierung neuer Gene wurden zunächst drei größere genomische Cosmid-/PAC-Contigs (I-III) im Bereich der Marker D4S114 bis D4S142 erstellt und mittels Exonamplifikation auf transkribierte Bereiche (Exons) untersucht. Es konnten insgesamt 67 putative 'Exons' isoliert werden, von denen einige bereits bekannten Genen (ZNF141, PDEB, MYL5, GAK, DAGK4 und FGFR3) entsprechen. Zwei dieser Gene konnten im Rahmen dieser Arbeit erstmals (DAGK4) bzw. genauer (GAK) in die distale Region 4p16.3 kartiert werden. Die restlichen Exons können aufgrund von Homologievergleichen und/oder EST-cDNA-Homologien vermutlich neuen Genen oder auch Pseudogenen (z. B. YWEE1hu) zugeordnet werden. Durch die im Verlaufe der vorliegenden Arbeit publizierte weitere Eingrenzung der WHSCR auf einen 165 Kb-großen Bereich proximal des FGFR3-Gens konzentrierten sich weitere Untersuchungen auf die detaillierte Analyse der WHSCR zwischen dem Marker D4S43 und FGFR3. Mit Hilfe von Exonamplifikation bzw. computergestützter Auswertung vorliegender Sequenzdaten aus diesem Bereich ('GRAIL', 'GENSCAN' und Homologievergleiche in den EST-Datenbanken des NCBI) konnten mehrere neue Gene identifiziert werden. In distaler-proximaler Reihenfolge handelt es sich dabei um die Gene LETM1, 51, 43, 45, 57 und POL4P. LETM1 kodiert für ein putatives Transmembran-Protein mit einem Leucin-Zipper- und zwei EF-Hand-Motiven und könnte aufgrund seiner möglichen Beteiligung an der Ca2+-Homeostase und/oder der Signal-transduktion zu Merkmalen des WHS (Krampfanfällen, mentale Retardierung und muskuläre Hypotonie) beitragen. Das Gen 51 entspricht einem in etwa zeitgleich durch Stec et al. (1998) und Chesi et al. (1998) als WHSC1 bzw. MMSET bezeichnetem Gen und wurde daher nicht weiter charakterisiert. Es wird genauso wie das Gen 43, das zeitgleich von Wright et al. (1999b) als WHSC2 beschrieben werden konnte und eine mögliche Rolle bei der Transkriptionselongation spielt, ubiquitär exprimiert. Das in der vorliegenden Arbeit identifizierte Gen 45 zeigt demgegenüber ein ausgesprochen spezifisches Expressionsmuster (in Nervenzellen des Gehirns sowie in Spermatiden). Dies stellt zusammen mit der strukturellen Ähnlichkeit des putativen Genprodukts zu Signalmolekülen einen interessanten Zusammenhang zu Merkmalen des WHS (beispielsweise Kryptorchismus, Uterusfehlbildungen oder auch neurologische Defekte) her. Demgegenüber handelt es sich bei dem Gen 57 möglicherweise um ein trunkiertes Pseudogen des eRFS-Gens auf Chromosom 6q24 (Wallrapp et al., 1998). Das POL4P-Gen schließlich stellt allein aufgrund seiner genomischen Lokalisation sowie seiner möglichen Funktion (als DNA-Polymerase-ähnliches Gen) kein gutes Kandidatengen für spezifische Merkmale des Syndroms dar und wurde daher nicht im Detail charakterisiert. Um die Beteiligung der Gene an der Ätiologie und Pathogenese des Syndroms zu verstehen, ist die Entwicklung eines Mausmodells (über das Einfügen gezielter Deletionen in das Mausgenom) geplant. Um dies zu ermöglichen, wurde in der vorliegenden Arbeit die Charakterisierung der orthologen Region bei der Maus vorgenommen. Zunächst wurden die orthologen Gene der Maus (Letm1, Whsc1, Gen 43 (Whsc2h), Gen 45 und Pol4p) identifiziert. Durch die Erstellung sowie die genaue Kartierung eines murinen genomischen P1/PAC-Klon-Contigs konnte gezeigt werden, daß die murinen Gene Fgfr3, Letm1, Whsc1, Gen 43 (Whsc2h), Gen 45 und Pol4p sowie einige weitere der überprüften EST-cDNA-Klone der Maus in einem durchgehenden Syntänieblock zwischen Mensch (POL4P bis FGFR3) und Maus (Mmu 5.20) enthalten sind, der in seiner genomischen Ausdehnung in etwa den Verhältnissen beim Menschen (zwischen POL4P und FGFR3) entspricht.

Anomalie cerebellari fetali: confronto tra ecografia e risonanza magnetica prenatale e follow up a distanza

Cerebellar malformation are increasingly diagnosed in utero. To assess the effectiveness of ultrasound and fetal magnetic resonance in the antenatal prediction of long term neurodevelopmental delay. STUDY DESIGN: We collected 105 cases of cerebellum malformation in the period 2000-2010 in Bologna and Bari University. Classification included cystic anomalies of posterior fossa and cerebellar hypoplasia. RESULTS: The greater group included Blake’s pouch cysts and mega cisterna magna cases (58/105). These cases seemed to have a good prognosis with a good outcome both in association with other anomalies and isolated. In cases of Dandy Walker malformation, vermis hypoplasia and cerebellum hypoplasia there were few survivors, so it was so difficult to outline some conclusion for child outcome. Despite great neuroimaging advances, in our study, ultrasound and MR reached a similar sensitivity (62-63%) for the diagnosis of posterior fossa anomalies, but the number of MR was lower compared with ultrasonography. CONCLUSION: Ultrasonography remains the screening method of choice for evaluation of cerebellum anatomy but probably MR imaging can improve some details expecially in the third trimester. Despite the data on Dandy Walker, vermis hypoplasia and cerebellum hypoplasia were conflicting and uncertain, for Blake and mega cisterna magna we can considered a rather good outcome.

Evidenza del coinvolgimento di geni nell'insorgenza delle schisi labio-palatine

The CL/P are the most common and easily recognizable craniofacial malformations with a complex etiology that requires the involvement of genetic and environmental components. The analysis of the genetic component shows more than 14 loci and genes involved in the onset of the disease. I’ve selected and investigated some of the possible candidate genes for CL/P. MYH14 gene, that maps on chromosome 19, on the OFC3 locus, and shows a strong homology with MYH9 gene. I’ve also investigated TP63 and MID1 genes, that are responsible respectively for EEC syndrome and Opitz syndrome, both of them presenting cleft. I’ve also decided to investigate JAG2 because TP63 product regulates the this gene, and both of them are component of the Notch signalling pathway. I’ve, also, studied the MKX and LMO4 genes. MKX is an important development regulator that is highly expressed in palatal mesenchyme, and map in the region responsible for Twirler mutation that cause cleft in mouse. LMO4 is necessary for neural tube development and cooperating with Grhl3, promotes cellular migration during morphogenetic events like “in utero” cleft healing. Low folate levels and high levels of homocysteine increase the risk of cleft, genes involved in their metabolism may be of interest in cleft occurrence. I’ve decided to investigate BHMT and CBS genes coding for enzymes involved in homocysteine metabolism. I’ve also investigated BHMT2 gene that maps close to BHMT and presents with him a 73% of homology. I’ve performed a linkage analysis using SNPs mapping in the genes and their boundaries, for each gene, for MKX and LMO4 I’ve also performed a sequencing analysis. My results for MID1 and CBS genes support the hypothesis of a possible role of these genes in cleft. I’ve found borderline association values for JAG2, MKX and LMO4 genes.

Untersuchungen zur Funktion und Regulation der Rezeptor-Tyrosin-Phosphatase RPTPlambda bei der Entwicklung des Mittel- und Hinterhirns

Der isthmische Organisator liegt an der Grenze zwischen dem sich entwickelnden Mittel- und Hinterhirn und kontrolliert Wachstum und Musterbildung dieser beiden Hirnregionen. In der vorliegenden Arbeit wird die räumliche und zeitliche Expression der Rezeptor-ähnlichen Protein Tyrosin Phosphatase lambda aus dem Huhn (cRPTPλ, auch als cRPTPψ bekannt) während der Entwicklung dieser Struktur beschrieben. Nach einer anfänglich weitläufigen Expression im kaudalen Vorderhirn und in der Mittelhirnregion, beschränkt sich die Expression von cRPTPλ zwischen dem embryonalen Tag E2 und E3.5 auf die ventrale Mittellinie des Neuralrohrs, den Bereich der späteren neuralen Retina und Linse und auf einen schmalen Ring anterior der isthmischen Einschnürung, welcher der molekularen Mittel- / Hinterhirngrenze (MHO) entspricht. Ab dem embryonalen Tag E3.5 wird RPTPλ dann auch im gesamten Mittelhirn gebildet. Um Hinweise auf die Funktion von cRPTPλ zu bekommen, wurde die Regulation dieses Moleküls untersucht. Die Expression von cRPTPλ am MHO wird von dem Fibroblasten Wachstumsfaktor Fgf8 und dem Transkriptionsfaktor Lmx1b, nicht aber von dem sezernierten Glykoprotein Wnt1 induziert. Der Transkriptionsfaktor En-1 unterdrückt die Expression von cRPTPλ am MHO. cRPTPλ-Expression im Mittelhirn wird negativ durch das sezernierte Protein Sonic Hedgehog reguliert, während Lmx1b und En-1 dort keinen Einfluss auf das Expressionsmuster von cRPTPλ haben. Fgf8 und Wnt1 sind maßgeblich an der Regulation von Wachstum und Musterbildung des embryonalen Mittelhirns beteiligt. Funktionelle Studien zu RPTPλ deuten darauf hin, dass dieses Protein als negativer Rückkopplungsmechanismus beider Signalwege wirken kann. RNAi- und Überexpressionsstudien am MHO lieferten Hinweise darauf, dass RPTPλ der Induktion der Wnt1-Expression durch Fgf8 entgegenwirkt. Dies scheint durch Interaktion noch unbekannter Faktoren mit der Juxtamembrandomäne von RPTPλ vermittelt zu werden. Auf das Expressionsmuster von Fgf8 selbst, oder einer Reihe anderer Faktoren, die ebenfalls von Fgf8 reguliert werden, hat RPTPλ allerdings keinen Einfluss. Des Weiteren konnte in dieser Arbeit gezeigt werden, dass eine „künstliche“ Aufrechterhaltung der Expression von cRPTPλ im Mittelhirn zwischen dem embryonalen Tag E2 und E3.5 zu einem stark verkleinerten Mesenzephalon führt. RPTPλ bindet in vivo an β-Catenin, ein zentrales Protein des kanonischen Wnt-Signalweges, und moduliert dadurch vermutlich das Wnt-Signal, welches seinerseits Proliferation im Mesenzephalon fördert. Durch diesen Mechanismus könnte cRPTPλ als „Bremse“ des kanonischen Wnt-Signalweges im Mittelhirn wirken.

Integrative Musterbildung kranialer Strukturen

Form und Gestalt kraniofazialer Strukturen sind primär beeinflusst durch die inhärente Integration der unterschiedlichsten Funktionssysteme und externer selektiver Einflüsse. Die Variabilität der Schädel-Morphe ist ein Indikator für solche Einflussfaktoren und damit ein idealer Gegenstand für vergleichende Analysen morphogenetischer Formbildung. Zur Ermittlung morphologisch-adaptiver Trends und Muster wurden sowohl Hypothesen zur morphologischen Differenziertheit als auch zu Korrelationen zwischen modularen Schädelkompartimenten (fazial, neurokranial, basikranial) untersucht. Zusätzlich wurden aus Schichtröntgenaufnahmen (CT) virtuelle Modelle rekonstruiert, welche die Interpretation der statistischen Befunde unterstützen sollten. Zur Berechnung der Gestaltunterschiede wurden mittels eines mechanischen Gelenkarm-Messgerätes (MicroScribe-G2) max. 85 ektokraniale Messpunkte (Landmarks) bzw. dreidimensionale Koordinaten an ca. 520 Schädeln von fünf rezenten Gattungen der Überfamilie Hominoidea (Hylobates, Pongo, Gorilla, Pan und Homo) akquiriert. Aus dem Datensatz wurden geometrische Störfaktoren (Größe, Translation, Rotation) mathematisch eliminiert und die verbleibenden Residuale bzw. ‚Gestalt-Variablen‘ diversen multivariat-statistischen Verfahren unterzogen (Faktoren, Cluster-, Regressions- und Korrelationsanalysen sowie statistische Tests). Die angewandten Methoden erhalten die geometrische Information der Untersuchungsobjekte über alle Analyseschritte hinweg und werden unter der Bezeichnung „Geometric Morphometrics (GMM)“ als aktueller Ansatz der Morphometrie zusammengefasst. Für die unterschiedlichen Fragestellungen wurden spezifische Datensätze generiert. Es konnten diverse morphologische Trends und adaptive Muster mit Hilfe der Synthese statistischer Methoden und computer-basierter Rekonstruktionen aus den generierten Datensätzen ermittelt werden. Außerdem war es möglich, präzise zu rekonstruieren, welche kranialen Strukturen innerhalb der Stichprobe miteinander wechselwirken, einzigartige Variabilitäten repräsentieren oder eher homogen gestaltet sind. Die vorliegenden Befunde lassen erkennen, dass Fazial- und Neurokranium am stärksten miteinander korrelieren, während das Basikranium geringe Abhängigkeiten in Bezug auf Gesichts- oder Hirnschädelveränderungen zeigte. Das Basikranium erweist sich zudem bei den nicht-menschlichen Hominoidea und über alle Analysen hinweg als konservative und evolutiv-persistente Struktur mit dem geringsten Veränderungs-Potential. Juvenile Individuen zeigen eine hohe Affinität zueinander und zu Formen mit einem kleinem Gesichts- und großem Hirnschädel. Während das Kranium des rezenten Menschen primär von Enkephalisation und fazialer Retraktion (Orthognathisierung) dominiert ist und somit eine einzigartige Gestalt aufweist, zeigt sich der Kauapparat als maßgeblich formbildendes Kompartiment bei den nicht-menschlichen Formen. Die Verbindung von GMM mit den interaktiven Möglichkeiten computergenerierter Modelle erwies sich als valides Werkzeug zur Erfassung der aufgeworfenen Fragestellungen. Die Interpretation der Befunde ist durch massive Interkorrelationen der untersuchten Strukturen und der statistisch-mathematischen Prozeduren als hoch komplex zu kennzeichnen. Die Studie präsentiert einen innovativen Ansatz der modernen Morphometrie, welcher für zukünftige Untersuchungen im Bereich der kraniofazialen Gestaltanalyse ausgebaut werden könnte. Dabei verspricht die Verknüpfung mit ‚klassischen’ und modernen Zugängen (z. B. Molekularbiologie) gesteigerte Erkenntnismöglichkeiten für künftige morphometrische Fragestellungen.