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Journal of Medical Genetics logoLink to Journal of Medical Genetics
. 2000 Jan;37(1):26–32. doi: 10.1136/jmg.37.1.26

Evidence for digenic inheritance in some cases of Antley-Bixler syndrome?

W Reardon 1, A Smith 1, J Honour 1, P Hindmarsh 1, D Das 1, G Rumsby 1, I Nelson 1, S Malcolm 1, L Ades 1, D Sillence 1, D Kumar 1, C DeLozier-Blanchet 1, S McKee 1, T Kelly 1, W McKeehan 1, M Baraitser 1, R Winter 1
PMCID: PMC1734444  PMID: 10633130

Abstract

The Antley-Bixler syndrome has been thought to be caused by an autosomal recessive gene. However, patients with this phenotype have been reported with a new dominant mutation at the FGFR2 locus as well as in the offspring of mothers taking the antifungal agent fluconazole during early pregnancy. In addition to the craniosynostosis and joint ankylosis which are the clinical hallmarks of the condition, many patients, especially females, have genital abnormalities. We now report abnormalities of steroid biogenesis in seven of 16 patients with an Antley-Bixler phenotype. Additionally, we identify FGFR2 mutations in seven of these 16 patients, including one patient with abnormal steroidogenesis. These findings, suggesting that some cases of Antley-Bixler syndrome are the outcome of two distinct genetic events, allow a hypothesis to be formulated under which we may explain all the differing and seemingly contradictory circumstances in which the Antley-Bixler phenotype has been recognised.


Keywords: Antley-Bixler syndrome; FGFR; congenital adrenal hyperplasia; CYP21 deficiency

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Selected References

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  1. Aleck K. A., Bartley D. L. Multiple malformation syndrome following fluconazole use in pregnancy: report of an additional patient. Am J Med Genet. 1997 Oct 31;72(3):253–256. [PubMed] [Google Scholar]
  2. Antley R., Bixler D. Trapezoidocephaly, midfacial hypoplasia and cartilage abnormalities with multiple synostoses and skeletal fractures. Birth Defects Orig Artic Ser. 1975;11(2):397–401. [PubMed] [Google Scholar]
  3. Bentley S. A., Kirby S. L., Anklesaria P., Greenberger J. S. Bone marrow stromal proteoglycan heterogeneity: phenotypic variability between cell lines and the effects of glucocorticoid. J Cell Physiol. 1988 Jul;136(1):182–187. doi: 10.1002/jcp.1041360124. [DOI] [PubMed] [Google Scholar]
  4. Chun K., Siegel-Bartelt J., Chitayat D., Phillips J., Ray P. N. FGFR2 mutation associated with clinical manifestations consistent with Antley-Bixler syndrome. Am J Med Genet. 1998 May 18;77(3):219–224. doi: 10.1002/(sici)1096-8628(19980518)77:3<219::aid-ajmg6>3.0.co;2-k. [DOI] [PubMed] [Google Scholar]
  5. Como J. A., Dismukes W. E. Oral azole drugs as systemic antifungal therapy. N Engl J Med. 1994 Jan 27;330(4):263–272. doi: 10.1056/NEJM199401273300407. [DOI] [PubMed] [Google Scholar]
  6. Crisponi G., Porcu C., Piu M. E. Antley-Bixler syndrome: case report and review of the literature. Clin Dysmorphol. 1997 Jan;6(1):61–68. [PubMed] [Google Scholar]
  7. DeLozier-Blanchet C. D. Antley-Bixler syndrome from a prognostic perspective. Am J Med Genet. 1989 Feb;32(2):262–263. doi: 10.1002/ajmg.1320320227. [DOI] [PubMed] [Google Scholar]
  8. DeLozier C. D., Antley R. M., Williams R., Green N., Heller R. M., Bixler D., Engel E. The syndrome of multisynostotic osteodysgenesis with long-bone fractures. Am J Med Genet. 1980;7(3):391–403. doi: 10.1002/ajmg.1320070322. [DOI] [PubMed] [Google Scholar]
  9. Feigin E., Udassin R., Seror D., Szold A., Ben Neriah Z., Glick B. Antley-Bixler syndrome and esophageal atresia in a patient with trisomy 21. Clin Genet. 1995 Jan;47(1):53–55. doi: 10.1111/j.1399-0004.1995.tb03922.x. [DOI] [PubMed] [Google Scholar]
  10. Galvin B. D., Hart K. C., Meyer A. N., Webster M. K., Donoghue D. J. Constitutive receptor activation by Crouzon syndrome mutations in fibroblast growth factor receptor (FGFR)2 and FGFR2/Neu chimeras. Proc Natl Acad Sci U S A. 1996 Jul 23;93(15):7894–7899. doi: 10.1073/pnas.93.15.7894. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Gorlin R. J. Patient described by Chun et al. may not present Antley-Bixler syndrome. Am J Med Genet. 1999 Mar 5;83(1):64–64. [PubMed] [Google Scholar]
  12. Gorry M. C., Preston R. A., White G. J., Zhang Y., Singhal V. K., Losken H. W., Parker M. G., Nwokoro N. A., Post J. C., Ehrlich G. D. Crouzon syndrome: mutations in two spliceoforms of FGFR2 and a common point mutation shared with Jackson-Weiss syndrome. Hum Mol Genet. 1995 Aug;4(8):1387–1390. doi: 10.1093/hmg/4.8.1387. [DOI] [PubMed] [Google Scholar]
  13. Gripp K. W., Stolle C. A., McDonald-McGinn D. M., Markowitz R. I., Bartlett S. P., Katowitz J. A., Muenke M., Zackai E. H. Phenotype of the fibroblast growth factor receptor 2 Ser351Cys mutation: Pfeiffer syndrome type III. Am J Med Genet. 1998 Jul 24;78(4):356–360. doi: 10.1002/(sici)1096-8628(19980724)78:4<356::aid-ajmg10>3.0.co;2-h. [DOI] [PubMed] [Google Scholar]
  14. Gripp K. W., Zackai E. H., Cohen M. M., Jr Not Antley-Bixler syndrome. Am J Med Genet. 1999 Mar 5;83(1):65–68. [PubMed] [Google Scholar]
  15. Hanger D. P., Jevons S., Shaw J. T. Fluconazole and testosterone: in vivo and in vitro studies. Antimicrob Agents Chemother. 1988 May;32(5):646–648. doi: 10.1128/aac.32.5.646. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Honour J. W. Steroid profiling. Ann Clin Biochem. 1997 Jan;34(Pt 1):32–44. doi: 10.1177/000456329703400106. [DOI] [PubMed] [Google Scholar]
  17. Inman W., Pearce G., Wilton L. Safety of fluconazole in the treatment of vaginal candidiasis. A prescription-event monitoring study, with special reference to the outcome of pregnancy. Eur J Clin Pharmacol. 1994;46(2):115–118. doi: 10.1007/BF00199872. [DOI] [PubMed] [Google Scholar]
  18. Kajiwara K., Berson E. L., Dryja T. P. Digenic retinitis pigmentosa due to mutations at the unlinked peripherin/RDS and ROM1 loci. Science. 1994 Jun 10;264(5165):1604–1608. doi: 10.1126/science.8202715. [DOI] [PubMed] [Google Scholar]
  19. Kan M., Wang F., To B., Gabriel J. L., McKeehan W. L. Divalent cations and heparin/heparan sulfate cooperate to control assembly and activity of the fibroblast growth factor receptor complex. J Biol Chem. 1996 Oct 18;271(42):26143–26148. doi: 10.1074/jbc.271.42.26143. [DOI] [PubMed] [Google Scholar]
  20. Kan M., Wu X., Wang F., McKeehan W. L. Specificity for fibroblast growth factors determined by heparan sulfate in a binary complex with the receptor kinase. J Biol Chem. 1999 May 28;274(22):15947–15952. doi: 10.1074/jbc.274.22.15947. [DOI] [PubMed] [Google Scholar]
  21. Kasinath B. S., Singh A. K., Kanwar Y. S., Lewis E. J. Dexamethasone increases heparan sulfate proteoglycan core protein content of glomerular epithelial cells. J Lab Clin Med. 1990 Feb;115(2):196–202. [PubMed] [Google Scholar]
  22. Kumar D., Masel J. P. A new multiple malformation syndrome of Müllerian dysgenesis and conductive hearing loss with facial hypoplasia, bilateral forearm deformity, brachydactyly, spinal stenosis and scoliosis. Clin Genet. 1997 Jul;52(1):30–36. doi: 10.1111/j.1399-0004.1997.tb02511.x. [DOI] [PubMed] [Google Scholar]
  23. LeHeup B. P., Masutti J. P., Droullé P., Tisserand J. The Antley-Bixler syndrome: report of two familial cases with severe renal and anal anomalies. Eur J Pediatr. 1995 Feb;154(2):130–133. doi: 10.1007/BF01991916. [DOI] [PubMed] [Google Scholar]
  24. Lee B. E., Feinberg M., Abraham J. J., Murthy A. R. Congenital malformations in an infant born to a woman treated with fluconazole. Pediatr Infect Dis J. 1992 Dec;11(12):1062–1064. [PubMed] [Google Scholar]
  25. Leppä S., Härkönen P., Jalkanen M. Steroid-induced epithelial-fibroblastic conversion associated with syndecan suppression in S115 mouse mammary tumor cells. Cell Regul. 1991 Jan;2(1):1–11. doi: 10.1091/mbc.2.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Loose D. S., Kan P. B., Hirst M. A., Marcus R. A., Feldman D. Ketoconazole blocks adrenal steroidogenesis by inhibiting cytochrome P450-dependent enzymes. J Clin Invest. 1983 May;71(5):1495–1499. doi: 10.1172/JCI110903. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Mastroiacovo P., Mazzone T., Botto L. D., Serafini M. A., Finardi A., Caramelli L., Fusco D. Prospective assessment of pregnancy outcomes after first-trimester exposure to fluconazole. Am J Obstet Gynecol. 1996 Dec;175(6):1645–1650. doi: 10.1016/s0002-9378(96)70119-9. [DOI] [PubMed] [Google Scholar]
  28. McKeehan W. L., Wang F., Kan M. The heparan sulfate-fibroblast growth factor family: diversity of structure and function. Prog Nucleic Acid Res Mol Biol. 1998;59:135–176. doi: 10.1016/s0079-6603(08)61031-4. [DOI] [PubMed] [Google Scholar]
  29. McKeehan W. L., Wu X., Kan M. Requirement for anticoagulant heparan sulfate in the fibroblast growth factor receptor complex. J Biol Chem. 1999 Jul 30;274(31):21511–21514. doi: 10.1074/jbc.274.31.21511. [DOI] [PubMed] [Google Scholar]
  30. Meyers G. A., Day D., Goldberg R., Daentl D. L., Przylepa K. A., Abrams L. J., Graham J. M., Jr, Feingold M., Moeschler J. B., Rawnsley E. FGFR2 exon IIIa and IIIc mutations in Crouzon, Jackson-Weiss, and Pfeiffer syndromes: evidence for missense changes, insertions, and a deletion due to alternative RNA splicing. Am J Hum Genet. 1996 Mar;58(3):491–498. [PMC free article] [PubMed] [Google Scholar]
  31. Morell R., Spritz R. A., Ho L., Pierpont J., Guo W., Friedman T. B., Asher J. H., Jr Apparent digenic inheritance of Waardenburg syndrome type 2 (WS2) and autosomal recessive ocular albinism (AROA). Hum Mol Genet. 1997 May;6(5):659–664. doi: 10.1093/hmg/6.5.659. [DOI] [PubMed] [Google Scholar]
  32. Munro C. S., Wilkie A. O. Epidermal mosaicism producing localised acne: somatic mutation in FGFR2. Lancet. 1998 Aug 29;352(9129):704–705. doi: 10.1016/S0140-6736(05)60820-3. [DOI] [PubMed] [Google Scholar]
  33. Ostlere L. S., Rumsby G., Holownia P., Jacobs H. S., Rustin M. H., Honour J. W. Carrier status for steroid 21-hydroxylase deficiency is only one factor in the variable phenotype of acne. Clin Endocrinol (Oxf) 1998 Feb;48(2):209–215. doi: 10.1046/j.1365-2265.1998.3811205.x. [DOI] [PubMed] [Google Scholar]
  34. Plomp A. S., Hamel B. C., Cobben J. M., Verloes A., Offermans J. P., Lajeunie E., Fryns J. P., de Die-Smulders C. E. Pfeiffer syndrome type 2: further delineation and review of the literature. Am J Med Genet. 1998 Jan 23;75(3):245–251. [PubMed] [Google Scholar]
  35. Poddevin F., Delobel B., Courreges P., Bayart M. Antley-Bixler syndrome: case report and review of the literature. Genet Couns. 1995;6(3):241–246. [PubMed] [Google Scholar]
  36. Pulleyn L. J., Reardon W., Wilkes D., Rutland P., Jones B. M., Hayward R., Hall C. M., Brueton L., Chun N., Lammer E. Spectrum of craniosynostosis phenotypes associated with novel mutations at the fibroblast growth factor receptor 2 locus. Eur J Hum Genet. 1996;4(5):283–291. doi: 10.1159/000472215. [DOI] [PubMed] [Google Scholar]
  37. Pursley T. J., Blomquist I. K., Abraham J., Andersen H. F., Bartley J. A. Fluconazole-induced congenital anomalies in three infants. Clin Infect Dis. 1996 Feb;22(2):336–340. doi: 10.1093/clinids/22.2.336. [DOI] [PubMed] [Google Scholar]
  38. Reardon W., Winter R. M., Rutland P., Pulleyn L. J., Jones B. M., Malcolm S. Mutations in the fibroblast growth factor receptor 2 gene cause Crouzon syndrome. Nat Genet. 1994 Sep;8(1):98–103. doi: 10.1038/ng0994-98. [DOI] [PubMed] [Google Scholar]
  39. Reardon W., Winter R. M. The molecular pathology of syndromic craniosynostosis. Mol Med Today. 1995 Dec;1(9):432–437. doi: 10.1016/s1357-4310(95)90837-4. [DOI] [PubMed] [Google Scholar]
  40. Rousseau F., Bonaventure J., Legeai-Mallet L., Pelet A., Rozet J. M., Maroteaux P., Le Merrer M., Munnich A. Mutations in the gene encoding fibroblast growth factor receptor-3 in achondroplasia. Nature. 1994 Sep 15;371(6494):252–254. doi: 10.1038/371252a0. [DOI] [PubMed] [Google Scholar]
  41. Rumsby G., Avey C. J., Conway G. S., Honour J. W. Genotype-phenotype analysis in late onset 21-hydroxylase deficiency in comparison to the classical forms. Clin Endocrinol (Oxf) 1998 Jun;48(6):707–711. doi: 10.1046/j.1365-2265.1998.00402.x. [DOI] [PubMed] [Google Scholar]
  42. Rutland P., Pulleyn L. J., Reardon W., Baraitser M., Hayward R., Jones B., Malcolm S., Winter R. M., Oldridge M., Slaney S. F. Identical mutations in the FGFR2 gene cause both Pfeiffer and Crouzon syndrome phenotypes. Nat Genet. 1995 Feb;9(2):173–176. doi: 10.1038/ng0295-173. [DOI] [PubMed] [Google Scholar]
  43. Schaefer F., Anderson C., Can B., Say B. Novel mutation in the FGFR2 gene at the same codon as the Crouzon syndrome mutations in a severe Pfeiffer syndrome type 2 case. Am J Med Genet. 1998 Jan 23;75(3):252–255. doi: 10.1002/(sici)1096-8628(19980123)75:3<252::aid-ajmg4>3.0.co;2-s. [DOI] [PubMed] [Google Scholar]
  44. Schinzel A., Savoldelli G., Briner J., Sigg P., Massini C. Antley-Bixler syndrome in sisters: a term newborn and a prenatally diagnosed fetus. Am J Med Genet. 1983 Jan;14(1):139–147. doi: 10.1002/ajmg.1320140119. [DOI] [PubMed] [Google Scholar]
  45. Shiang R., Thompson L. M., Zhu Y. Z., Church D. M., Fielder T. J., Bocian M., Winokur S. T., Wasmuth J. J. Mutations in the transmembrane domain of FGFR3 cause the most common genetic form of dwarfism, achondroplasia. Cell. 1994 Jul 29;78(2):335–342. doi: 10.1016/0092-8674(94)90302-6. [DOI] [PubMed] [Google Scholar]
  46. Sonino N. The use of ketoconazole as an inhibitor of steroid production. N Engl J Med. 1987 Sep 24;317(13):812–818. doi: 10.1056/NEJM198709243171307. [DOI] [PubMed] [Google Scholar]
  47. Suzuki K., Kanda Y., Sugiyama K., Katoh T., Wada Y., Yasui Y. Antley-Bixler syndrome in a sister and brother. Jinrui Idengaku Zasshi. 1987 Sep;32(3):247–252. doi: 10.1007/BF01876879. [DOI] [PubMed] [Google Scholar]
  48. Tartaglia M., Valeri S., Velardi F., Di Rocco C., Battaglia P. A. Trp290Cys mutation in exon IIIa of the fibroblast growth factor receptor 2 (FGFR2) gene is associated with Pfeiffer syndrome. Hum Genet. 1997 May;99(5):602–606. doi: 10.1007/s004390050413. [DOI] [PubMed] [Google Scholar]
  49. Tavormina P. L., Shiang R., Thompson L. M., Zhu Y. Z., Wilkin D. J., Lachman R. S., Wilcox W. R., Rimoin D. L., Cohn D. H., Wasmuth J. J. Thanatophoric dysplasia (types I and II) caused by distinct mutations in fibroblast growth factor receptor 3. Nat Genet. 1995 Mar;9(3):321–328. doi: 10.1038/ng0395-321. [DOI] [PubMed] [Google Scholar]
  50. Wang F., Kan M., McKeehan K., Jang J. H., Feng S., McKeehan W. L. A homeo-interaction sequence in the ectodomain of the fibroblast growth factor receptor. J Biol Chem. 1997 Sep 19;272(38):23887–23895. doi: 10.1074/jbc.272.38.23887. [DOI] [PubMed] [Google Scholar]
  51. Wilkie A. O. Craniosynostosis: genes and mechanisms. Hum Mol Genet. 1997;6(10):1647–1656. doi: 10.1093/hmg/6.10.1647. [DOI] [PubMed] [Google Scholar]
  52. Yasui Y., Yamaguchi A., Itoh Y., Ueke T., Sugiyama K., Wada Y. The first case of the Antley-Bixler syndrome with a consanguinity in Japan. Jinrui Idengaku Zasshi. 1983 Sep;28(3):215–220. doi: 10.1007/BF01876602. [DOI] [PubMed] [Google Scholar]

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