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Coats syndrome in facioscapulohumeral dystrophy type 1: frequency and D4Z4 contraction size
Jeffrey M Statland1, Sabrina Sacconi, Constantine Farmakidis
1Departments of Neurology, University of Rochester Medical Center, Rochester, NY, USA. Jeffrey_Statland@URMC.Rochester.edu
Insights
Coats syndrome is a rare complication in facioscapulohumeral muscular dystrophy type 1 (FSHD1), often linked to larger D4Z4 contractions. Increased eye surveillance is recommended for FSHD1 patients with D4Z4 fragments up to 15 kb.
Area of Science:
- Ophthalmology
- Genetics
- Neurology
Background:
- Facioscapulohumeral muscular dystrophy type 1 (FSHD1) is a genetic disorder affecting muscles.
- Coats syndrome is a rare eye condition characterized by abnormal blood vessel development in the retina.
- The association between FSHD1 and Coats syndrome, particularly concerning D4Z4 contraction size, requires further investigation.
Purpose of the Study:
- To determine the frequency of Coats syndrome in patients with FSHD1.
- To explore the relationship between D4Z4 contraction size and the occurrence of Coats syndrome in FSHD1 patients.
Main Methods:
- Searched North American FSHD registry and University of Rochester database.
- Reviewed existing literature and surveyed 14 international FSHD referral centers.
- Identified and analyzed data from genetically confirmed FSHD1 patients diagnosed with Coats syndrome, including D4Z4 contraction size.
Main Results:
- Identified 14 patients with FSHD and confirmed Coats syndrome.
- The median D4Z4 fragment size in affected patients was 13 kb.
- Coats syndrome was diagnosed at a median age of 10 years.
Conclusions:
- Coats syndrome is a rare extramuscular manifestation of FSHD1.
- Large D4Z4 contractions are associated with Coats syndrome in FSHD1.
- Retinal complication surveillance is advised for FSHD1 patients with D4Z4 fragments ≤15 kb.
Objective:
To investigate the frequency of Coats syndrome and its association with D4Z4 contraction size in patients with facioscapulohumeral muscular dystrophy type 1 (FSHD1).
Methods:
We searched a North American FSHD registry and the University of Rochester (UR) FSHD research database, reviewed the literature, and sent surveys to 14 FSHD referral centers in the United States and overseas to identify patients with genetically confirmed FSHD1 with a diagnosis of Coats syndrome.
Results:
Out of 357 genetically confirmed patients in a North American FSHD registry and 51 patients in the UR database, 3 patients had a self-reported history of Coats disease (0.8%; 95% confidence interval 0.2%-2.2%). In total, we identified 14 patients with FSHD with known genetic contraction size and Coats syndrome confirmed by ophthalmologic examination: 10 from our survey and 4 from the literature. The median age at diagnosis of Coats syndrome was 10 years (interquartile range 14 years). The median D4Z4 fragment size was 13 kilobases (kb) (interquartile range 1 kb). One patient was mosaic (55% 11 kb, and 45% 78 kb).
Conclusions:
Coats syndrome is a rare extramuscular complication of FSHD1 associated with large D4Z4 contractions. Closer surveillance for retinal complications is warranted in patients with D4Z4 fragments ≤15 kb.
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