| Myotonic dystrophy |
| Classification and external resources |
| ICD-10 |
G71.1 |
| OMIM |
160900 602668 |
| DiseasesDB |
8739 |
| MeSH |
D009223 |
| GeneReviews |
- Myotonic Dystrophy Type 1
- Myotonic Dystrophy Type 2
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Myotonic dystrophy (dystrophia myotonica, myotonia atrophica) is a chronic, slowly progressing, highly variable, inherited multisystemic disease.
It is characterized by wasting of the muscles (muscular dystrophy), cataracts, heart conduction defects, endocrine changes, and myotonia. Two types of myotonic dystrophy exist.
Myotonic dystrophy type 1 (DM1), also called Steinert disease, has a severe congenital form and a milder childhood-onset form. Myotonic dystrophy type 2 (DM2), also called proximal myotonic myopathy (PROMM) is rarer than DM1 and generally manifests with milder signs and symptoms. Myotonic dystrophy can occur in patients of any age. Both forms of the disease display an autosomal dominant pattern of inheritance. Both "DM1" and "DM2" have Adult-Onset forms.
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Contents
- 1 Description/Classification
- 2 Symptoms and signs
- 3 Genetics
- 4 Diagnosis
- 4.1 Prenatal testing
- 4.2 Predictive testing
- 5 Management
- 6 Physical Therapy Interventions
- 6.1 Physical Activity
- 6.2 Orthotics
- 6.3 Mobility Aids and Adaptive Equipment
- 7 Epidemiology
- 8 Continual Research
- 9 References
- 10 External links
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Description/Classification
Comparison between myotonic dystrophy subtypes
| Type |
Gene |
Repeat |
Anticipation |
Severity |
| DM1 |
DMPK |
CTG |
Yes |
Moderate-severe |
| DM2 |
ZNF9 |
CCTG |
Minimal/none |
Mild-moderate |
Two types of myotonic dystrophy exist. Type 1 (DM1), also known as Steinert disease, has a severe congenital form and a milder childhood-onset form as well as an Adult-onset form. Type 2 (DM2), also known as proximal myotonic myopathy (PROMM), is rarer and generally manifests with milder signs and symptoms than DM1.
Other forms of myotonic dystrophy not associated with DM1 or DM2 genetic mutations have been described.[1] One case which was proposed as a candidate for the "DM3" label,[2] was later characterized as an unusual form of inclusion body myopathy associated with Paget's disease and frontotemporal dementia.[1][3][4]
Myotonic dystrophy (DM) is an inherited disease, affecting males and females approximately equally. About 30,000 people in the United States are affected. Symptoms may appear at any time from infancy to adulthood. DM causes general weakness, usually beginning in the muscles of the hands, feet, neck, or face. It slowly progresses to involve other muscle groups, including the heart. DM affects a wide variety of other organ systems as well. A severe form of DM, congenital myotonic dystrophy or Thomsen's disease, may appear in newborns of mothers who have DM. Congenital means that the condition is present from birth. The incidence of congenital myotonic dystrophy is thought to be about 1:20,000. DM occurs in about 1 per 7,000–8,000 people and has been described in people from all over the world.
Symptoms and signs
40-year-old patient with myotonic dystrophy presenting with bilateral cataracts and complete heart block.
Presentation of symptoms and signs varies considerably by form (DM1/DM2), severity and even unusual DM2 phenotypes. DM1 symptoms for DM2 include problems with executive function (e.g., organization, concentration, word-finding) and hypersomnia. Conduction abnormalities are more common in DM1 than DM2, but all patients are advised to have an annual ECG. Both types are also associated with insulin resistance. Myotonic dystrophy patients may have a cortical cataract with a blue dot appearance, or a posterior subcapsular cataract.[5]
DM2 is generally milder than DM1, with generally fewer DM2 patients requiring assistive devices than DM1 patients.[citation needed] In addition, the severe congenital form that affects babies in DM1 has not been found in DM2 and the early onset of symptoms is rarely noted to appear in younger patients in the medical literature.
Genetics
Myotonic dystrophy is inherited in an autosomal dominant pattern.
Myotonic dystrophy is a genetic condition which is inherited in an autosomal dominant pattern and thus will be passed along to 50% of a carrier's offspring, on average.
Myotonic dystrophy is one of several known trinucleotide repeat disorders. Certain areas of DNA have repeated sequences of two or three nucleotides.
===DM1 — In DM1, the affected gene is called DMPK, which codes for myotonic dystrophy protein kinase,[6] a protein expressed predominantly in skeletal muscle.[7] The gene is located on the long arm of chromosome 19.[8]
In DM1, there is an expansion of the cytosine-thymine-guanine (CTG) triplet repeat in the DMPK gene. Between 5 and 37 repeats is considered normal, while individuals with between 38 and 49 repeats are considered to have a pre-mutation and are at risk of having children with further expanded repeats and, therefore, symptomatic disease.[1] Individuals with greater than 50 repeats are almost invariably symptomatic, with some noted exceptions.[ref] Longer repeats are usually associated with earlier onset and more severe disease.
DMPK alleles with greater than 37 repeats are unstable and additional trinucleotide repeats may be inserted during cell division in mitosis and meiosis. Consequently, the children of individuals with premutations or mutations inherit DMPK alleles which are longer than their parents and therefore are more likely to be affected or display an earlier onset and greater severity of the condition, a phenomenon known as anticipation. Interestingly, paternal transmission of the condition is very uncommon, possibly due to selection pressures against sperm with expanded repeats, but anticipation tends to be more severe than in cases of maternal inheritance.
DM2
Histopathology of DM2. Muscle biopsy showing mild myopathic changes and grouping of atrophic fast fibres (type 2, highlighted). Immunohistochemical staining for type-1 ("slow") myosin
DM2 is caused by a defect of the ZNF9 gene on chromosome 3.[9] The specific defect is a repeat of the cytosine-cytosine-thymine-guanosine (CCTG) tetranucleotide in the ZNF9 gene.[9] As it involves the repeat of four nucleotides, it is not a trinucleotide repeat disorder, but rather a tetranucleotide repeat disorder.[10]
The repeat expansion for DM2 is much larger than for DM1, ranging from 75 to over 11,000 repeats.[9] Unlike in DM1, the size of the repeated DNA expansion in DM2 does not appear to make a difference in the age of onset or disease severity.[1] Anticipation appears to be less significant in DM2 and most current reviews only report mild anticipation as a feature of DM2.
Diagnosis
The diagnosis of DM1 and DM2 can be difficult due to the large number of neuromuscular disorders, most of which are very rare. More than 40 neuromuscular disorders exist with close to 100 variants.[citation needed]
As a result, patients with multiple symptoms that may be explained by a complex disorder such as DM1 or DM2 will generally be referred by their primary care physician to a neurologist for diagnosis. Depending on the presentation of symptoms, patients may be referred to a number of medical specialists including cardiologists, ophthalmologists, endocrinologists, and rheumatologists. In addition, the clinical presentation is obscured by the degree of severity or the presence of unusual phenotypes.
It is common that the clinical presentation for both DM1 and DM2 patients does not conform to the perceptions of these diseases held by many neurologists. Clinicians who are less familiar with the myotonic dystrophies in their day to day practice may expect patients with both forms to present with the more severe classic symptoms of DM1. As a result, patients may remain undiagnosed or be misdiagnosed. A useful clinical clue for diagnosis is the failure of spontaneous letting go of the hands following strong handshakes due to myotonia (delayed relaxation of muscles after contraction) which accompanies muscle weakness.
Even though there is presently no cure for DM and management is currently symptom based, a precise diagnosis is still necessary because of multiple other problems that may develop over time (e.g. cataracts). An accurate diagnosis is important to assist with appropriate medical monitoring and medical management of symptoms. In addition, genetic counseling should be made available to all patients because of the high risk of transmission. Potentially serious anesthetic risks are important to note, so the presence of this disorder should be brought to the attention of all medical providers.
Prenatal testing
Genetic tests, including prenatal testing, are available for both confirmed forms. Molecular testing is considered the gold standard of diagnosis.
Testing at pregnancy to determine whether an unborn child is affected is possible if genetic testing in a family has identified a DMPK mutation. This can be done at 10–12 weeks gestation by a procedure called chorionic villus sampling (CVS) that involves removing a tiny piece of the placenta and analyzing DNA from its cells. It can also be done by amniocentesis after 14 weeks gestation by removing a small amount of the amniotic fluid surrounding the baby and analyzing the cells in the fluid. Each of these procedures has a small risk of miscarriage associated with it and those who are interested in learning more should check with their doctor or genetic counselor. There is also another procedure called preimplantation diagnosis that allows a couple to have a child that is unaffected with the genetic condition in their family. This procedure is experimental and not widely available. Those interested in learning more about this procedure should check with their doctor or genetic counselor.
Predictive testing
It is possible to test someone who is at risk for developing DM1 before they are showing symptoms to see whether they inherited an expanded trinucleotide repeat. This is called predictive testing. Predictive testing cannot determine the age of onset that someone will begin to have symptoms, or the course of the disease.
Management
There is currently no cure for or treatment specific to myotonic dystrophy. Therefore, the focus is on managing the complications of the disease, particularly those relating to the cardiopulmonary system as these account for 70% of deaths due to DM1.[1] Pacemaker insertion may be required for individuals with cardiac conduction abnormalities. Central sleep apnoea or obstructive sleep apnoea may cause excessive daytime sleepiness, and these individuals should undergo a sleep study. Non-invasive ventilation may be offered if there is an abnormality. Otherwise, there is evidence for the use of modafinil as a central nervous system stimulant, although a Cochrane review has described the evidence thus far as inconclusive.
Some small studies have suggested that imipramine, clomipramine and taurine may be useful in the treatment of myotonia.[1] However, due to the weak evidence and potential side effects such as cardiac arrhythmias, these treatments are rarely used.
Altered splicing of the muscle-specific chloride channel 1 (ClC-1) has been shown to cause the myotonic phenotype of DM1 and is reversible in mouse models using Morpholino antisense to modify splicing of ClC-1 mRNA.[11]
Physical Therapy Interventions
Physical Activity
Combined strengthening and aerobic training at moderate intensity was deemed safe for individuals with neuromuscular diseases[12] and the combination was found to increase muscle strength.[13] Specifically, aerobic exercise via stationary bicycle with an ergometer was found to be safe and effective in improving fitness in DM1 patients.[14] The strength training or aerobic exercise may promote muscle and cardiorespiratory function, while preventing further disuse atrophy.[12] Cardiovascular impairments and myotonic sensitivities to exercise and temperature necessitate close monitoring of patients and educating patients in self-monitoring during exercise via the Borg scale, heart rate monitors, and other physical exertion measurements.[15]
Orthotics
Muscular weakness of dorsiflexors (dorsiflexion) hinders the ability to clear the floor during the swing phase of gait and patients may adopt a steppage gait pattern [15] or ankle-foot-orthotics may be indicated.[1] Factors such as hand function, skin integrity, and comfort must be assessed prior to prescription. Neck braces can also be prescribed for neck muscle weakness.[1]
Mobility Aids and Adaptive Equipment
Upper and lower limb weakness, visual impairments and myotonia may lead to the need for mobility aids and functional adaptive equipment such as buttonhooks and handled sponges for optimal hand function. If assistive devices and home adaptations are needed, physical therapists may refer onto occupational therapist(s) for further assessment.[1]
Epidemiology
DM1 is the most common form of muscular dystrophy diagnosed in children, with a prevalence ranging from 1 per 100,000 in Japan to 3-15 per 100,000 in Europe.[1] The prevalence may be as high as 1 in 500 in regions such as Quebec, possibly due to the founder effect. In most populations, DM1 appears to be more common than DM2. However, recent studies suggest that type 2 may be as common as type 1 among people in Germany and Finland.[16]
Continual Research
The years since the discovery of the genetic cause of MMD in 1992 have been fruitful ones for MMD research. Scientists are gaining understanding of how the expanded DNA section on chromosome 19 causes so many physiologic changes. Such discoveries are likely to provide valuable insights for future treatment avenues. In the meantime, scientists are also working to test drug treatments that may help symptoms in MMD. Among these are a drug that can make muscles more sensitive to insulin, one that may help improve muscle function and one that may relieve myotonia. The ultimate ―cure for MMD would probably require finding a way to block the expanded area of DNA on chromosome 19 or chromosome 3 so that it would lose its toxic effect on cells. It is not far-fetched to imagine that, in the future, this expanded section of DNA could be blocked or ―silenced. Scientists around the world are studying the unusual biological mechanisms that underlie MMD and working on pathways to treatment. However, it needs to be understood that such a treatment will take many years to be sufficiently developed to be used on humans.
References
- ^ a b c d e f g h i j Turner, C; Hilton-Jones D. (2010). "The myotonic dystrophies: diagnosis and management". J Neurol Neurosurg Psychiatry 81: 358–367. doi:10.1136/jnnp.2008.158261. PMID 20176601.
- ^ Le Ber I, Martinez M, Campion D, et al. (2004). "A non-DM1, non-DM2 multisystem myotonic disorder with frontotemporal dementia: phenotype and suggestive mapping of the DM3 locus to chromosome 15q21-24". Brain 127 (Pt 9): 1979–92. doi:10.1093/brain/awh216. PMID 15215218.
- ^ GeneReview/NCBI/NIH/UW entry on Myotonic Dystrophy Type 2
- ^ Udd B, Meola G, Krahe R, et al. (2006). "140th ENMC International Workshop: Myotonic Dystrophy DM2/PROMM and other myotonic dystrophies with guidelines on management". Neuromuscul. Disord. 16 (6): 403–13. doi:10.1016/j.nmd.2006.03.010. PMID 16684600.
- ^ Yanoff, Myron; Jay S. Duker (2008). Ophthalmology (3rd ed. ed.). Edinburgh: Mosby. p. 411. ISBN 978-0323057516.
- ^ Mahadevan M, Tsilfidis C, Sabourin L, et al. (March 1992). "Myotonic dystrophy mutation: an unstable CTG repeat in the 3' untranslated region of the gene". Science 255 (5049): 1253–5. doi:10.1126/science.1546325. PMID 1546325.
- ^ van der Ven PF, Jansen G, van Kuppevelt TH, et al. (November 1993). "Myotonic dystrophy kinase is a component of neuromuscular junctions". Human Molecular Genetics 2 (11): 1889–94. doi:10.1093/hmg/2.11.1889. PMID 8281152.
- ^ Harley HG, Walsh KV, Rundle S, et al. (May 1991). "Localisation of the myotonic dystrophy locus to 19q13.2-19q13.3 and its relationship to twelve polymorphic loci on 19q". Human Genetics 87 (1): 73–80. doi:10.1007/BF01213096. PMID 2037285.
- ^ a b c Day JW, Ricker K, Jacobsen JF, et al. (February 2003). "Myotonic dystrophy type 2: molecular, diagnostic and clinical spectrum". Neurology 60 (4): 657–64. doi:10.1001/archneur.60.5.657. PMID 12601109.
- ^ Liquori CL, Ricker K, Moseley ML, et al. (August 2001). "Myotonic dystrophy type 2 caused by a CCTG expansion in intron 1 of ZNF9". Science 293 (5531): 864–7. doi:10.1126/science.1062125. PMID 11486088.
- ^ Wheeler TM, Lueck JD, Swanson MS, Dirksen RT, Thornton CA (2007). "Correction of ClC-1 splicing eliminates chloride channelopathy and myotonia in mouse models of myotonic dystrophy". J. Clin. Invest. 117 (12): 3952–7. doi:10.1172/JCI33355. PMC 2075481. PMID 18008009.
- ^ a b Voet NB, van der Kooi EL, Riphagen II, Lindeman E, van Engelen BG, Geurts ACh (2010). "Strength training and aerobic exercise training for muscle disease". Cochrane Database Syst Rev (1): CD003907. doi:10.1002/14651858.CD003907.pub3. PMID 20091552.
- ^ Cup EH, Pieterse AJ, Ten Broek-Pastoor JM, et al. (November 2007). "Exercise therapy and other types of physical therapy for patients with neuromuscular diseases: a systematic review". Arch Phys Med Rehabil 88 (11): 1452–64. doi:10.1016/j.apmr.2007.07.024. PMID 17964887.
- ^ Orngreen MC, Olsen DB, Vissing J (May 2005). "Aerobic training in patients with myotonic dystrophy type 1". Ann. Neurol. 57 (5): 754–7. doi:10.1002/ana.20460. PMID 15852373.
- ^ a b Pandya, S and Eichinger, K. "Role of physical therapy in the assessment and management of individuals with myotonic dystrophy". Myotonic Dystrophy Foundation. Retrieved 5 May 2012.
- ^ Myotonic dystrophy at NLM Genetics Home Reference
External links
- Myotonic dystrophy at NLM Genetics Home Reference
- GeneReview/NCBI/NIH/UW entry on Myotonic Dystrophy Type 1
- GeneReview/NCBI/NIH/UW entry on Myotonic Dystrophy Type 2
- Searchable database at Dutch Neuromuscular Research
- Udd B, Meola G, Krahe R, et al. (June 2006). "140th ENMC International Workshop: Myotonic Dystrophy DM2/PROMM and other myotonic dystrophies with guidelines on management". Neuromuscul. Disord. 16 (6): 403–13. doi:10.1016/j.nmd.2006.03.010. PMID 16684600. Myotonic Dystrophy DM2/PROMM and other Myotonic dystrophies]
- Information from the Myotonic Dystrophy Foundation
- Information from the International Myotonic Dystrophy Organization (IMDO)
- MDSG Information
- Information from Myotonic Dystrophy Canada (DMCanada)
- Information from the Neuromuscular Disease Center
- DM Toolbox Research tools for Myotonic Dystrophy from the Marigold Foundation
- Facts about myotonic muscular dystrophy from Myotonic Dystrophy Association
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Muscular dystrophy
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| The Nine Primary Muscular Dystrophies |
Congenital • dystrophin (Becker's, Duchenne) • Distal • Emery-Dreifuss • Facioscapulohumeral • Limb-girdle muscular dystrophy • Myotonic • Oculopharyngeal
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Related topics
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| National/International Organizations |
Muscular Dystrophy Association (USA) • Muscular Dystrophy Canada • Myotonic Dystrophy Foundation
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| US government Institutes and Legislation |
NINDS • NIAMS • NICHD • MD CARE Act • Genetic Information Nondiscrimination Act • Americans with Disabilities Act of 1990
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| National/International Events |
MDA Muscle Walk (USA) • MDA Show of Strength (USA) • Décrypthon (France)
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| Recent or Ongoing Clinical Trials |
Stamulumab (MYO-029)
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anat (h/n, u, t/d, a/p, l)/phys/devp/hist
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noco (m, s, c)/cong (d)/tumr, sysi/epon, injr
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Diseases of myoneural junction and muscle / neuromuscular disease (G70–G73, 358–359)
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Neuromuscular-
junction disease |
- autoimmune
- Myasthenia gravis
- Lambert–Eaton myasthenic syndrome
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Myopathy/
congenital myopathy |
Muscular dystrophy
(DAPC) |
| AD |
- Limb-girdle muscular dystrophy 1
- Oculopharyngeal
- Facioscapulohumeral
- Myotonic
- Distal (most)
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| AR |
- Limb-girdle muscular dystrophy 2
- Congenital
- Fukuyama
- Ullrich
- Walker–Warburg
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| XR |
- dystrophin
- Emery–Dreifuss
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| Other structural |
- collagen disease
- PTP disease
- adaptor protein disease
- BIN1-linked centronuclear myopathy
- cytoskeleton disease
- Nemaline myopathy
- Zaspopathy
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| Channelopathy |
| Myotonia |
- Myotonia congenita
- Thomsen disease
- Neuromyotonia/Isaacs syndrome
- Paramyotonia congenita
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| Periodic paralysis |
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| Other |
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| Mitochondrial myopathy |
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| Other |
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anat (h/n, u, t/d, a/p, l)/phys/devp/hist
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noco (m, s, c)/cong (d)/tumr, sysi/epon, injr
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Non-Mendelian inheritance: anticipation
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| Trinucleotide |
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Polyglutamine (PolyQ), CAG
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- Dentatorubral-pallidoluysian atrophy
- Huntington's disease
- Kennedy disease
- Spinocerebellar ataxia 1, 2, 3, 6, 7, 17 (Machado-Joseph disease)
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Non-Polyglutamine
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- CGG (Fragile X syndrome)
- GAA (Friedreich's ataxia)
- CTG (Myotonic dystrophy type 1)
- CTG (Spinocerebellar ataxia 8)
- CAG (Spinocerebellar ataxia 12)
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| Tetranucleotide |
- CCTG (Myotonic dystrophy type 2)
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| Pentanucleotide |
- ATTCT (Spinocerebellar ataxia 10)
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Deficiencies of intracellular signaling peptides and proteins
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| GTP-binding protein regulators |
| GTPase-activating protein |
- Neurofibromatosis type I
- Watson syndrome
- Tuberous sclerosis
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| Guanine nucleotide exchange factor |
- Marinesco–Sjögren syndrome
- Aarskog–Scott syndrome
- Juvenile primary lateral sclerosis
- X-Linked mental retardation 1
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| G protein |
| Heterotrimeic |
- cAMP/GNAS1: Pseudopseudohypoparathyroidism
- Progressive osseous heteroplasia
- Pseudohypoparathyroidism
- Albright's hereditary osteodystrophy
- McCune–Albright syndrome
CGL 2
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| Monomeric |
- RAS: HRAS
- KRAS
- Noonan syndrome 3
- KRAS Cardiofaciocutaneous syndrome
- RAB: RAB7
- Charcot–Marie–Tooth disease
- RAB23
- RAB27
- Griscelli syndrome type 2
- RHO: RAC2
- Neutrophil immunodeficiency syndrome
- ARF: SAR1B
- Chylomicron retention disease
- ARL13B
- ARL6
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| MAP kinase |
- Cardiofaciocutaneous syndrome
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| Other kinase/phosphatase |
| Tyrosine kinase |
- BTK
- X-linked agammaglobulinemia
- ZAP70
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| Serine/threonine kinase |
- RPS6KA3
- CHEK2
- IKBKG
- STK11
- DMPK
- ATR
- GRK1
- WNK4/WNK1
- Pseudohypoaldosteronism 2
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| Tyrosine phosphatase |
- PTEN
- Bannayan–Riley–Ruvalcaba syndrome
- Lhermitte–Duclos disease
- Cowden syndrome
- Proteus-like syndrome
- MTM1
- X-linked myotubular myopathy)
- PTPN11
- Noonan syndrome 1
- LEOPARD syndrome
- Metachondromatosis
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| Signal transducing adaptor proteins |
- EDARADD
- EDARADD Hypohidrotic ectodermal dysplasia
- SH3BP2
- LDB3
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| Other |
- NF2
- Neurofibromatosis type II
- NOTCH3
- PRKAR1A
- PRKAG2
- Wolff–Parkinson–White syndrome
- PRKCSH
- PRKCSH Polycystic liver disease
- XIAP
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see also intracellular signaling peptides and proteins
- B structural
- perx
- skel
- cili
- mito
- nucl
- sclr
- DNA/RNA/protein synthesis
- membrane
- transduction
- trfk
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Genetic disorder, protein biosynthesis: Transcription factor/coregulator deficiencies
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| (1) Basic domains |
1.2: Feingold syndrome · Saethre–Chotzen syndrome
1.3: Tietz syndrome
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(2) Zinc finger
DNA-binding domains |
2.1 (Intracellular receptor): Thyroid hormone resistance · Androgen insensitivity syndrome (PAIS, MAIS, CAIS) · Kennedy's disease · PHA1AD pseudohypoaldosteronism · Estrogen insensitivity syndrome · X-linked adrenal hypoplasia congenita · MODY 1 · Familial partial lipodystrophy 3 · SF1 XY gonadal dysgenesis
2.2: Barakat syndrome · Tricho–rhino–phalangeal syndrome
2.3: Greig cephalopolysyndactyly syndrome/Pallister–Hall syndrome · Denys–Drash syndrome · Duane-radial ray syndrome · MODY 7 · MRX 89 · Townes–Brocks syndrome · Acrocallosal syndrome · Myotonic dystrophy 2
2.5: Autoimmune polyendocrine syndrome type 1
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| (3) Helix-turn-helix domains |
3.1: ARX (Ohtahara syndrome, Lissencephaly X2) · HLXB9 (Currarino syndrome) · HOXD13 (SPD1 Synpolydactyly) · IPF1 (MODY 4) · LMX1B (Nail–patella syndrome) · MSX1 (Tooth and nail syndrome, OFC5) · PITX2 (Axenfeld syndrome 1) · POU4F3 (DFNA15) · POU3F4 (DFNX2) · ZEB1 (Posterior polymorphous corneal dystrophy 3, Fuchs' dystrophy 3) · ZEB2 (Mowat–Wilson syndrome)
3.2: PAX2 (Papillorenal syndrome) · PAX3 (Waardenburg syndrome 1&3) · PAX4 (MODY 9) · PAX6 (Gillespie syndrome, Coloboma of optic nerve) · PAX8 (Congenital hypothyroidism 2) · PAX9 (STHAG3)
3.3: FOXC1 (Axenfeld syndrome 3, Iridogoniodysgenesis, dominant type) · FOXC2 (Lymphedema–distichiasis syndrome) · FOXE1 (Bamforth–Lazarus syndrome) · FOXE3 (Anterior segment mesenchymal dysgenesis) · FOXF1 (ACD/MPV) · FOXI1 (Enlarged vestibular aqueduct) · FOXL2 (Premature ovarian failure 3) · FOXP3 (IPEX)
3.5: IRF6 (Van der Woude syndrome, Popliteal pterygium syndrome)
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(4) β-Scaffold factors
with minor groove contacts |
4.2: Hyperimmunoglobulin E syndrome
4.3: Holt–Oram syndrome · Li–Fraumeni syndrome · Ulnar–mammary syndrome
4.7: Campomelic dysplasia · MODY 3 · MODY 5 · SF1 (SRY XY gonadal dysgenesis, Premature ovarian failure 7) · SOX10 (Waardenburg syndrome 4c, Yemenite deaf-blind hypopigmentation syndrome)
4.11: Cleidocranial dysostosis
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| (0) Other transcription factors |
0.6: Kabuki syndrome
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| Ungrouped |
TCF4 (Pitt–Hopkins syndrome) · ZFP57 (TNDM1) · TP63 (Rapp–Hodgkin syndrome/Hay–Wells syndrome/Ectrodactyly–ectodermal dysplasia–cleft syndrome 3/Limb–mammary syndrome/OFC8)
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| Transcription coregulators |
coactivator: CREBBP (Rubinstein–Taybi syndrome)
corepressor: HR (Atrichia with papular lesions)
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see also transcription factors
- B structural
- perx
- skel
- cili
- mito
- nucl
- sclr
- DNA/RNA/protein synthesis
- membrane
- transduction
- trfk
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