Frasier syndrome

Frasier syndrome is a urogenital anomaly associated with the WT1 (Wilms tumor 1 gene) gene.[1][2][3]

For the anatomical abnormality observed in 1965, see Fraser syndrome.
Frasier syndrome
SpecialtyEndocrinology, obstetrics and gynaecology, urology, medical genetics 

It was first characterized in 1964.[4]

Presentation

Frasier syndrome presents at birth with male pseudohermaphroditism (the external genitalia have a female appearance despite an XY genotype), streak gonads and progressive glomerulonephropathy (focal segmental glomerulosclerosis). Patients are also at increased risk of genito-urinary tumors (usually gonadoblastoma).

The glomerulonephropathy presents later than in Denys-Drash syndrome, and the tumour risk phenotype is different; whilst Denys-Drash syndrome is associated with Wilms' tumour, Frasier syndrome is associated with gonadoblastoma. Differentiating between the two syndromes can be challenging.[5]

Genetics

The WT1 gene exists on chromosome 11 (at 11p13), and codes for a four zinc finger transcription factor. Its role as a transcription factor is related to proper kidney and gonadal development.[6][7] The link between kidney and gonadal development and WT1 was highlighted in past studies looking at the related Denys-Drash syndrome. Results of various investigations identified the loss of function of WT1 to be a prerequisite of Wilms' tumour development, and also a key trait of individuals with genital abnormalities.[8]

Mutations responsible for Frasier syndrome predominantly occur in intron 9 of the WT1 gene, specifically nucleotide substitutions that influence an intron splice site. Mutations in this region proved for the absence of three amino acids—KTS—between the third and fourth WT1 zinc fingers.[9] Referring to the autosomal dominant expressive nature of this disease, it is only necessary for an individual to have one complement of the mutated intronic sequence to appear affected.[10] Differing from the similar Denys-Drash syndrome, where a mutated form of the WT1 protein exists, Frasier syndrome expression works solely on the existence of a changed ratio of KTS isoforms: normal WT1 proteins including the KTS site (+KTS), and mutated, shortened proteins lacking the KTS site (–KTS).[1] Through alternative splicing, a specific ratio of the two isoforms normally exists, though the mutation in the intron 9 splice site severely lowers levels of the +KTS isoform; this leads to Frasier syndrome.[9]

Inheritance pattern

Frasier syndrome is inherited in an autosomal dominant fashion, indicating the need for only one mutated allele in a cell to lead to expression of the disease. Mutations predominantly occur de novo, allowing for expression in an individual that has no family history of it. The mutations occur during gamete formation or early in embryogenesis.[10]

Treatment

Reconstructive surgery.

References
  1. Klamt B, Koziell A, Poulat F, et al. (April 1998). "Frasier syndrome is caused by defective alternative splicing of WT1 leading to an altered ratio of WT1 +/-KTS splice isoforms". Hum. Mol. Genet. 7 (4): 709–14. doi:10.1093/hmg/7.4.709. PMID 9499425.
  2. Reference, Genetics Home. "Frasier syndrome". Genetics Home Reference. Retrieved 2018-04-17.
  3. "Frasier syndrome | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program". rarediseases.info.nih.gov. Retrieved 2018-04-17.
  4. Frasier, SD; Bashore, SD; Bashore, RA; Mosier, HD (May 1964). "Gonadoblastoma associated with pure gonadal dysgenesis in monozygous twins". J. Pediatr. 64 (5): 740–5. doi:10.1016/S0022-3476(64)80622-3. PMID 14149008.
  5. https://www.ncbi.nlm.nih.gov/omim/136680
  6. Dai YL.; Fu JF.; Hong F.; et al. (Jul 2011). "WT1 mutation as a cause of 46 XY DSD and Wilm's tumour: a case report and literature review". Acta Paediatrica. 100 (7): 39–52. doi:10.1111/j.1651-2227.2011.02167.x. PMID 21314844.
  7. "WT1". Genetics Home Reference. U.S. National Library of Medicine. Retrieved 10 November 2014.
  8. Hastie, Nicholas D. (Aug 1992). "Dominant negative mutations in the Wilms tumour (WT1) gene cause Denys-Drash syndrome--proof that a tumour-suppressor gene plays a crucial role in normal genitourinary development". Hum Mol Genet. 1 (5): 293–5. doi:10.1093/hmg/1.5.293. PMID 1338905.
  9. Barbaux S.; Niaudet P.; Gubler MC.; et al. (Dec 1997). "Donor splice-site mutations in WT1 are responsible for Frasier syndrome". Nature Genetics. 17 (4): 467–70. doi:10.1038/ng1297-467. PMID 9398852.
  10. "Frasier syndrome". Genetics Home Reference. U.S. National Library of Medicine. Retrieved 10 November 2014.
Classification
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