RNF213 variants in a child with PHACE syndrome and moyamoya vasculopathy
Kala F Schilter1, Jack E Steiner1, Wendy Demos2
1Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Insights
Segmental infantile hemangiomas (IH) can link to congenital anomalies. This study links RNF213 gene variants to moyamoya vasculopathy (MMV) in patients with hemangioma syndromes and cerebral arterial anomalies.
Area of Science:
- Genetics
- Neurology
- Pediatrics
Background:
- Segmental infantile hemangiomas (IH) are associated with regional congenital anomalies.
- PHACE syndrome involves cervicofacial IH, aortic arch, head/neck artery anomalies, and posterior fossa/eye structural issues.
- A subset of PHACE patients develop moyamoya vasculopathy (MMV), characterized by internal carotid artery stenosis and collateral vessel formation.
Observation:
- A patient presented with MMV and segmental IH on the back and lower body.
- The patient met PHACE diagnostic criteria due to posterior segment eye anomaly and cerebral arterial anomalies.
- Whole exome sequencing identified two inherited heterozygous variants in the RNF213 gene.
Findings:
- RNF213 gene variants are linked to an increased susceptibility to developing MMV.
- The identified RNF213 variants may contribute to MMV development in patients with hemangioma syndromes.
- This case highlights a potential genetic link between RNF213 variants and cerebral arterial anomalies in hemangioma syndromes.
Implications:
- Suggests RNF213 variants play a role in MMV pathogenesis within specific hemangioma-associated syndromes.
- Highlights the importance of genetic screening (RNF213) in patients with PHACE and MMV.
- Advances understanding of the genetic underpinnings of complex vascular and structural anomalies in infantile hemangioma patients.
Abstract:
Segmental infantile hemangiomas (IH) can be associated with congenital anomalies in a regional distribution. PHACE refers to large cervicofacial segmental IH in association with congenital anomalies of the aortic arch and medium-sized arteries of the head and neck, as well as structural anomalies of the posterior fossa and eye. A subset of PHACE patients have arterial anomalies that progress to moyamoya vasculopathy (MMV). MMV is defined as stenosis of the supraclinoid segment of the internal carotid arteries and/or their major branches, with subsequent development of a compensatory collateral vessel network. We describe a patient with MMV and segmental IH on the back and lower body who meets diagnostic criteria for PHACE based on a posterior segment eye anomaly and cerebral arterial anomalies. Whole exome sequencing demonstrated two inherited heterozygous variants in RNF213. Variants in RNF213 are associated with increased susceptibility to MMV. Our findings suggest that RNF213 variants may play a role in the development of MMV in patients with hemangioma syndromes associated with congenital cerebral arterial anomalies.
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