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Genetics of Cockayne Syndrome Clinical Presentation

  • Author: David Flannery, MD, FAAP, FACMG; Chief Editor: Maria Descartes, MD  more...
 
Updated: Nov 16, 2015
 

History

Patients with Cockayne syndrome (CS) present with delayed psychomotor development, poor feeding, photosensitive rashes, and cataracts.

  • Delayed psychomotor development: All patients with Cockayne syndrome type 1 (CKN1) have mental retardation. The delay becomes apparent around the age when walking and speech should be developing.
  • Poor feeding: Some patients present during infancy with weak or poor feeding; however, the diagnosis is usually not made at this time.
  • Photosensitive rashes: More than 75% of patients have photosensitivity. Other skin findings include decreased amounts of subcutaneous tissue, dry scaly skin, and thin dry hair.
  • Cataracts: The presence of cataracts in children younger than 3 years is associated with the severe form of CKN1, which demonstrates a poorer prognosis and results in death at an earlier age.[2]
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Physical

In the first year, all patients with CKN1 demonstrate growth failure, which includes progressive microcephaly in most patients.

  • Neurologic examination shows increased or decreased muscle tone and reflexes. Ambulant patients present with an unusual gait resulting from leg spasticity, ataxia, and contractures of the hips, knees, and ankles.
  • Pigmentary degeneration of the retina is one hallmark of this disorder, with cataracts and optic atrophy or optic disk pallor as frequent findings.
  • Ophthalmologic changes are progressive.
  • More than one half of patients with CKN1 have mild-to-severe sensorineural hearing loss.
  • Many patients have moderate-to-severe dental caries; permanent teeth have short roots.
  • Most patients have photodermatitis that leads to dry scaly skin. Patients develop an aged appearance as a result of the disease process.
  • Major structural anomalies of the renal system rarely occur. Some patients develop decreased creatinine clearance but usually do not require medical treatment.
  • Cryptorchidism or testicular hypoplasia affects approximately one third of males. Females have menses, although cycles are irregular. Puberty may be delayed in both sexes.
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Causes

See the list below:

  • CKN1 is caused by a defect in the Cockayne syndrome type A gene (CSA or ERCC8) located on chromosome 5.[3] Affected persons inherit 2 mutant genes, one from each parent. Cells carrying ERCC8 mutations are hypersensitive to UV light. They do not recover the ability to synthesize RNA after exposure to UV light. In addition, the cells cannot remove and degrade DNA lesions from strands that have active transcription.
  • Mutations in the DNA excision repair gene ERCC6 located on band 10q11 cause CS type 2 (MIM number 133540; CSB).[4, 5] This gene encodes helicase, a protein that is presumed to have DNA unwinding function. Mutations include a deletion of exon 4, an amino acid substitution at the 106th glutamine to proline (Q106P) in the WD-40 repeat motif of the CSA protein, and large deletion in the upstream region, including exon 1 of the CSA gene. The Q106P mutation could alter the propeller structure of the CSA protein, which is important for the formation of the CSA protein complex. Additionally, a missense mutation (A205P) and a nonsense (E13X) mutation have been identified, as well as a new common single nucleotide polymorphism in CKN1. No genotype-phenotype correlation is known.
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Contributor Information and Disclosures
Author

David Flannery, MD, FAAP, FACMG Vice Chair of Education, Chief, Section of Medical Genetics, Professor, Department of Pediatrics, Medical College of Georgia

David Flannery, MD, FAAP, FACMG is a member of the following medical societies: American Academy of Pediatrics, American College of Medical Genetics and Genomics

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

David Flannery, MD, FAAP, FACMG Vice Chair of Education, Chief, Section of Medical Genetics, Professor, Department of Pediatrics, Medical College of Georgia

David Flannery, MD, FAAP, FACMG is a member of the following medical societies: American Academy of Pediatrics, American College of Medical Genetics and Genomics

Disclosure: Nothing to disclose.

Chief Editor

Maria Descartes, MD Professor, Department of Human Genetics and Department of Pediatrics, University of Alabama at Birmingham School of Medicine

Maria Descartes, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Medical Genetics and Genomics, American Medical Association, American Society of Human Genetics, Society for Inherited Metabolic Disorders, International Skeletal Dysplasia Society, Southeastern Regional Genetics Group

Disclosure: Nothing to disclose.

Additional Contributors

Elaine H Zackai, MD Professor of Pediatrics, Professor of Obstetrics and Gynecology, Professor of Pediatrics in Human Genetics, University of Pennsylvania School of Medicine; Director, Clinical Genetics Center, University of Pennsylvania; Senior Physician and Director of Clinical Genetics, The Children's Hospital of Philadelphia

Elaine H Zackai, MD is a member of the following medical societies: American Cleft Palate-Craniofacial Association, American College of Medical Genetics and Genomics, American Society of Human Genetics

Disclosure: Nothing to disclose.

References
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  2. Wilson BT, Stark Z, Sutton RE, et al. The Cockayne Syndrome Natural History (CoSyNH) study: clinical findings in 102 individuals and recommendations for care. Genet Med. 2015 Jul 23. [Medline].

  3. Khayat M, Hardouf H, Zlotogora J, Shalev SA. High carriers frequency of an apparently ancient founder mutation p.Tyr322X in the ERCC8 gene responsible for Cockayne syndrome among Christian Arabs in Northern Israel. Am J Med Genet A. 2010 Dec. 152A(12):3091-4. [Medline].

  4. Laugel V, Dalloz C, Durand M, et al. Mutation update for the CSB/ERCC6 and CSA/ERCC8 genes involved in Cockayne syndrome. Hum Mutat. 2009 Nov 5. [Medline].

  5. Zhang H, Gao J, Ye J, Gong Z, Gu X. Maternal origin of a de novo microdeletion spanning the ERCC6 gene in a classic form of the Cockayne syndrome. Eur J Med Genet. 2011 Jul-Aug. 54(4):e389-93. [Medline].

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  8. Chien YH, Chou HC, Hwu WL. Cockayne syndrome in a family. Acta Paediatr Taiwan. 2002 Jan-Feb. 43(1):46-9. [Medline].

  9. Cleaver JE, Thompson LH, Richardson AS, States JC. A summary of mutations in the UV-sensitive disorders: xeroderma pigmentosum, Cockayne syndrome, and trichothiodystrophy. Hum Mutat. 1999. 14(1):9-22. [Medline].

  10. Greenhaw GA, Hebert A, Duke-Woodside ME, et al. Xeroderma pigmentosum and Cockayne syndrome: overlapping clinical and biochemical phenotypes. Am J Hum Genet. 1992 Apr. 50(4):677-89. [Medline].

  11. Higginbottom MC, Griswold WR, Jones KL, et al. The Cockayne syndrome: an evaluation of hypertension and studies of renal pathology. Pediatrics. 1979 Dec. 64(6):929-34. [Medline].

  12. Kleijer WJ, van der Sterre ML, Garritsen VH. Prenatal diagnosis of the Cockayne syndrome: survey of 15 years experience. Prenat Diagn. 2006 Oct. 26(10):980-4. [Medline].

  13. Lehmann AR, Francis AJ, Giannelli F. Prenatal diagnosis of Cockayne's syndrome. Lancet. 1985 Mar 2. 1(8427):486-8. [Medline].

  14. Mathur R, Chowdhury MR, Singh G. Recent advances in chromosome breakage syndromes and their diagnosis. Indian Pediatr. 2000 Jun. 37(6):615-25. [Medline].

  15. Moyer DB, Marquis P, Shertzer ME, Burton BK. Cockayne syndrome with early onset of manifestations. Am J Med Genet. 1982 Oct. 13(2):225-30. [Medline].

  16. Nance MA, Berry SA. Cockayne syndrome: review of 140 cases. Am J Med Genet. 1992 Jan 1. 42(1):68-84. [Medline].

  17. Proops R, Taylor AM, Insley J. A clinical study of a family with Cockayne's syndrome. J Med Genet. 1981 Aug. 18(4):288-93. [Medline].

  18. Rapin I, Weidenheim K, Lindenbaum Y. Cockayne syndrome in adults: review with clinical and pathologic study of a new case. J Child Neurol. 2006 Nov. 21(11):991-1006. [Medline].

  19. Ren Y, Saijo M, Nakatsu Y, et al. Three novel mutations responsible for Cockayne syndrome group A. Genes Genet Syst. 2003 Feb. 78(1):93-102. [Medline].

  20. Sugita T, Ikenaga M, Suehara N, et al. Prenatal diagnosis of Cockayne syndrome using assay of colony-forming ability in ultraviolet light irradiated cells. Clin Genet. 1982 Sep. 22(3):137-42. [Medline].

  21. Tan WH, Baris H, Robson CD, Kimonis VE. Cockayne syndrome: the developing phenotype. Am J Med Genet A. 2005 Jun 1. 135(2):214-6. [Medline].

  22. Traboulsi EI, De Becker I, Maumenee IH. Ocular findings in Cockayne syndrome. Am J Ophthalmol. 1992 Nov 15. 114(5):579-83. [Medline].

  23. Venema J, Mullenders LH, Natarajan AT, et al. The genetic defect in Cockayne syndrome is associated with a defect in repair of UV-induced DNA damage in transcriptionally active DNA. Proc Natl Acad Sci U S A. 1990 Jun. 87(12):4707-11. [Medline].

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Autosomal recessive inheritance pattern.
 
 
 
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