Tissue-specific telomere shortening and degenerative changes in a patient with TINF2 mutation and dyskeratosis congenita
Dyskeratosis congenita is a disease of impaired tissue maintenance downstream of telomere dysfunction. Characteristically, patients present with the clinical triad of nail dystrophy, oral leukoplakia, and skin pigmentation defects, but the disease involves degenerative changes in multiple organs. Mu...
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doaj-93a563d42702472f944c367b6bf213e92021-09-05T04:40:29ZengElsevierHuman Pathology: Case Reports2214-33002021-09-0125200517Tissue-specific telomere shortening and degenerative changes in a patient with TINF2 mutation and dyskeratosis congenitaCaitlin M. Roake0Marisa Juntilla1Rajni Agarwal-Hashmi2Steven Artandi3Christin S. Kuo4Stanford University School of Medicine, Stanford, CA 94305, United StatesDepartment of Pathology, Stanford University School of Medicine, Stanford, CA 94305, United StatesDepartment of Pediatrics, Stem-cell Transplantation, Stanford University School of Medicine, Stanford, CA 94305, United StatesStanford Cancer Institute, Stanford University School of Medicine, Stanford, CA 94305, United StatesDepartment of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, United States; Corresponding author.Dyskeratosis congenita is a disease of impaired tissue maintenance downstream of telomere dysfunction. Characteristically, patients present with the clinical triad of nail dystrophy, oral leukoplakia, and skin pigmentation defects, but the disease involves degenerative changes in multiple organs. Mutations in telomere-binding proteins such as TINF2 (TRF1-interacting nuclear factor 2) or in telomerase, the enzyme that counteracts age related telomere shortening, are causative in dyskeratosis congenita. We present a patient who presented with severe hypoxemia at age 13. The patient had a history of myelodysplastic syndrome treated with bone marrow transplant at the age of 5. At age 18 she was hospitalized for an acute pneumonia progressing to respiratory failure, developed renal failure and ultimately, she and her family opted to withdraw support as she was not a candidate for a lung transplant. Sequencing of the patient’s TINF2 locus revealed a heterozygous mutation (c.844C > T, Arg282Cys) which has previously been reported in a subset of dyskeratosis congenita patients. Tissue sections from multiple organs showed degenerative changes including disorganized bone remodeling, diffuse alveolar damage and small vessel proliferation in the lung, and hyperkeratosis with hyperpigmentation of the skin. Autopsy samples revealed a bimodal distribution of telomere length, with telomeres from donor hematopoietic tissues being an age-appropriate length and those from patient tissues showing pathogenic shortening, with the shortest telomeres in lung, liver, and kidney. We report for the first time a survey of degenerative changes and telomere lengths in multiple organs in a patient with dyskeratosis congenita.http://www.sciencedirect.com/science/article/pii/S2214330021000468Dyskeratosis congenitaTelomere lengthHypoxemiaPediatric bone marrow failure |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Caitlin M. Roake Marisa Juntilla Rajni Agarwal-Hashmi Steven Artandi Christin S. Kuo |
spellingShingle |
Caitlin M. Roake Marisa Juntilla Rajni Agarwal-Hashmi Steven Artandi Christin S. Kuo Tissue-specific telomere shortening and degenerative changes in a patient with TINF2 mutation and dyskeratosis congenita Human Pathology: Case Reports Dyskeratosis congenita Telomere length Hypoxemia Pediatric bone marrow failure |
author_facet |
Caitlin M. Roake Marisa Juntilla Rajni Agarwal-Hashmi Steven Artandi Christin S. Kuo |
author_sort |
Caitlin M. Roake |
title |
Tissue-specific telomere shortening and degenerative changes in a patient with TINF2 mutation and dyskeratosis congenita |
title_short |
Tissue-specific telomere shortening and degenerative changes in a patient with TINF2 mutation and dyskeratosis congenita |
title_full |
Tissue-specific telomere shortening and degenerative changes in a patient with TINF2 mutation and dyskeratosis congenita |
title_fullStr |
Tissue-specific telomere shortening and degenerative changes in a patient with TINF2 mutation and dyskeratosis congenita |
title_full_unstemmed |
Tissue-specific telomere shortening and degenerative changes in a patient with TINF2 mutation and dyskeratosis congenita |
title_sort |
tissue-specific telomere shortening and degenerative changes in a patient with tinf2 mutation and dyskeratosis congenita |
publisher |
Elsevier |
series |
Human Pathology: Case Reports |
issn |
2214-3300 |
publishDate |
2021-09-01 |
description |
Dyskeratosis congenita is a disease of impaired tissue maintenance downstream of telomere dysfunction. Characteristically, patients present with the clinical triad of nail dystrophy, oral leukoplakia, and skin pigmentation defects, but the disease involves degenerative changes in multiple organs. Mutations in telomere-binding proteins such as TINF2 (TRF1-interacting nuclear factor 2) or in telomerase, the enzyme that counteracts age related telomere shortening, are causative in dyskeratosis congenita. We present a patient who presented with severe hypoxemia at age 13. The patient had a history of myelodysplastic syndrome treated with bone marrow transplant at the age of 5. At age 18 she was hospitalized for an acute pneumonia progressing to respiratory failure, developed renal failure and ultimately, she and her family opted to withdraw support as she was not a candidate for a lung transplant. Sequencing of the patient’s TINF2 locus revealed a heterozygous mutation (c.844C > T, Arg282Cys) which has previously been reported in a subset of dyskeratosis congenita patients. Tissue sections from multiple organs showed degenerative changes including disorganized bone remodeling, diffuse alveolar damage and small vessel proliferation in the lung, and hyperkeratosis with hyperpigmentation of the skin. Autopsy samples revealed a bimodal distribution of telomere length, with telomeres from donor hematopoietic tissues being an age-appropriate length and those from patient tissues showing pathogenic shortening, with the shortest telomeres in lung, liver, and kidney. We report for the first time a survey of degenerative changes and telomere lengths in multiple organs in a patient with dyskeratosis congenita. |
topic |
Dyskeratosis congenita Telomere length Hypoxemia Pediatric bone marrow failure |
url |
http://www.sciencedirect.com/science/article/pii/S2214330021000468 |
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