Abstract
Milroy disease (hereditary lymphoedema type I, MIM 153100) is a congenital onset primary lymphoedema with autosomal dominant inheritance. Mutations in the gene, vascular endothelial growth factor receptor 3, VEGFR3 (FLT4), are known to cause Milroy disease, but there is uncertainty about the prevalence of VEGFR3 mutations in patients with primary lymphoedema and more specifically in those with a phenotype that resembles Milroy disease. This study aims to address this issue and thereby delineate the Milroy disease phenotype. Fifty-two patients with primary lymphoedema were analysed for mutations in the coding regions of VEGFR3. Patients were divided into four groups: Typical Milroy disease with family history (group I), typical Milroy disease with no family history (group II), atypical Milroy disease (group III), and complex primary lymphoedema (group IV). Results demonstrated that with rigorous phenotyping the likelihood of detecting VEGFR3 mutations is optimised. Mutation prevalence is 75% in typical Milroy patients with a family history (group I) and 68% if positive family history is not a diagnostic criterion. A positive family history is not essential in Milroy disease. The likelihood of detecting VEGFR3 mutations in patients who have a phenotype which is not typical of Milroy disease is very small (<5%). For the 22 mutation positive patients, 14 novel VEGFR3 mutations were identified, two of which were in exon 22 and one in exon 17, confirming that these exons should be included in VEGFR3 analysis. No mutations were found outside the kinase domains, showing that analysis of this part of the gene is not useful for Milroy disease patients. VEGFC, which encodes the ligand for VEGFR3, was sequenced in all patients with typical Milroy disease (groups I and II) and no mutations were identified.
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Acknowledgments
F. C. Connell and C. Carver were supported by the British heart Foundation (BHF). P. Ostergaard was supported by the Daphne Jackson Trust and now the British Skin Foundation (BSF). We would like to thank the Reece Spence Fund for their support. The research used the resources of the Biomics Unit at St George’s University of London. Members of the Lymphoedema Consortium not in the author list were: Kevin Burnand, Russell Mellor, Alberto Smith, Mansoor Sarfarazi, David Goudie, Jill Clayton-Smith, Sarjhu Mehta, Ruth Newbury Ecob, Sarah Smithson, Fancesca Forzano, Beatrice Vesti, Andrea Guala, Cesare Danesino, Anne Child.
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F. C. Connell and P. Ostergaard contributed equally to this work.
An erratum to this article can be found at http://dx.doi.org/10.1007/s00439-009-0633-x
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Connell, F.C., Ostergaard, P., Carver, C. et al. Analysis of the coding regions of VEGFR3 and VEGFC in Milroy disease and other primary lymphoedemas. Hum Genet 124, 625–631 (2009). https://doi.org/10.1007/s00439-008-0586-5
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DOI: https://doi.org/10.1007/s00439-008-0586-5