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Journal of Bone and Mineral Metabolism

, Volume 34, Issue 5, pp 599–603 | Cite as

Characterization of an acromesomelic dysplasia, Grebe type case: novel mutation affecting the recognition motif at the processing site of GDF5

  • Monica Martinez-GarciaEmail author
  • Eva Garcia-Canto
  • Maria Fenollar-Cortes
  • Antonio Perez Aytes
  • María José Trujillo-Tiebas
Case Report

Abstract

Acromesomelic dysplasia, Grebe type is a very rare skeletal dysplasia characterized by severe dwarfism with marked micromelia and deformation of the upper and lower limbs, with a proximodistal gradient of severity. CDMP1 gene mutations have been associated with Grebe syndrome, Hunter–Thompson syndrome, Du Pan syndrome and brachydactyly type C. The proband is a 4-year-old boy, born of consanguineous Pakistani parents. Radiographic imaging revealed features typical of Grebe syndrome: severe shortening of the forearms with an acromesomelic pattern following a proximodistal gradient, with distal parts more severely affected than medial parts; hypoplastic hands, with the phalangeal zone more affected than the metacarpal zone; and severe hypoplastic tibial/femoral zones in both limbs. After molecular analyses, the p.Arg377Trp variant in a homozygous pattern was identified in the CDMP1 gene in the affected child. In silico and structural analyses predicted the p.Arg377Trp amino acid change to be pathogenic. Of the 34 mutations described in the CDMP1 gene, four different missense mutations have been associated with Grebe syndrome. The CDMP1 gene encodes growth differentiation factor 5 (GDF5), which plays a role in regulation of limb patterning, joint formation and distal bone growth. Homozygous mutations in the mature domain of GDF5 result in severe limb malformations such as the Grebe type or the Hunter–Thompson type of acromesomelic chondrodysplasia. The p.Arg377Trp mutation is located within the recognition motif at the processing site of GDF5 where the sequence RRKRR changes to WRKRR. The genotype–phenotype correlation allowed not only confirmation of the clinical diagnosis but also appropriate genetic counselling to be offered to this family.

Keywords

Skeletal CDMP1 Grebe Growth differentiation factor 5 Pakistan 

Notes

Acknowledgments

We thank Rosa Riveiro-Alvarez for her contribution to this work. This work was supported by the Fundación Ramon Areces (4715/001), and the author, Monica Martinez-Garcia, was supported by the Fundación Conchita Rábago de Jiménez Díaz.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© The Japanese Society for Bone and Mineral Research and Springer Japan 2015

Authors and Affiliations

  • Monica Martinez-Garcia
    • 1
    • 2
    Email author
  • Eva Garcia-Canto
    • 3
  • Maria Fenollar-Cortes
    • 4
  • Antonio Perez Aytes
    • 5
    • 6
  • María José Trujillo-Tiebas
    • 1
    • 2
  1. 1.Servicio de GenéticaHospital Fundación Jiménez DíazMadridSpain
  2. 2.Centro de Investigación Biomédica en Red de Enfermedades RarasMadridSpain
  3. 3.Servicio de PediatríaHospital Marina BaixaAlicanteSpain
  4. 4.Sección de Genética Clínica, Servicio de Análisis ClínicosHospital Clínico San CarlosMadridSpain
  5. 5.Unidad de Dismorfología y Genética ReproductivaHospital Universitario y Politecnico La FeValenciaSpain
  6. 6.Grupo de Investigación en PerinatologíaInstituto de Investigación Sanitaria Hospital La FeValenciaSpain

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