Axenfeld–Rieger syndrome

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Synonyms Axenfeld syndrome, Hagedoom syndrome
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Axenfeld–Rieger syndrome is a rare autosomal dominant[2] disorder, which affects the development of the teeth, eyes, and abdominal region.[3]

Pathophysiology[edit | edit source]

Axenfeld–Rieger syndrome has an autosomal dominant pattern of inheritance.[4]

The molecular genetics of Axenfeld–Rieger syndrome are poorly understood, but center on three genes identified by cloning of chromosomal breakpoints from patients.[5][6]

This disorder is inheritable as an autosomal dominant trait,[4] which means the defective gene is located on an autosome, and only one copy of the gene is sufficient to cause the disorder when inherited from a parent who has the disorder. As shown in the diagram, this gives a 50/50 chance of offspring inheriting the condition from an affected parent. syndrome citation needed (November 2016)


Diagnosis[edit | edit source]

Although most recognized for its correlation with the onset of glaucoma, the malformation is not limited to the eye, as Axenfeld–Rieger syndrome when associated with the PITX2 genetic mutation usually presents congenital malformations of the face, teeth, and skeletal system.[7]

The most characteristic feature affecting the eye is a distinct corneal posterior arcuate ring, known as an "embryotoxon".[8] In severe cases iris may be adherent to the cornea anterior to the Schwalbe's line.[9]

One of the three known genetic mutations which cause Rieger syndrome can be identified through genetic samples analysis. About 40% of Axenfeld–Rieger sufferers have displayed mutations in genes PITX2,[7] FOXC1, and PAX6.[10][11] The difference between Type 1, 2, and 3 Axenfeld–Rieger syndrome is the genetic cause, all three types display the same symptoms and abnormalities.[12]

Classification[edit | edit source]

The OMIM classification is as follows:

Type OMIM Gene
Type 1 Online Mendelian Inheritance in Man (OMIM) 180500 PITX2
Type 2 Online Mendelian Inheritance in Man (OMIM) 601499 possibly FOXO1A[13]
Type 3 Online Mendelian Inheritance in Man (OMIM) 602482 FOXC1
DeHauwere syndrome Online Mendelian Inheritance in Man (OMIM) 109120 Unknown[10]

Detection of any of these mutations can give patients a clear diagnosis and prenatal procedures such as preimplantation genetic diagnosis, chorionic villus sampling and amniocentesis can be offered to patients and prospective parents.[14]

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Management[edit | edit source]


Eponym[edit | edit source]

It is named after the German ophthalmologist Theodor Axenfeld[15][8] who studied anterior segment disorders, especially those such as Rieger syndrome and the Axenfeld anomaly. syndrome citation needed (November 2016)


Axenfeld–Rieger syndrome is characterized by abnormalities of the eyes, teeth, and facial structure.[12] Rieger syndrome, by medical definition, is determined by the presence of malformed teeth, underdeveloped anterior segment of the eyes, and cardiac problems associated with the Axenfeld anomaly.[13] The term "Rieger syndrome" is sometimes used to indicate an association with glaucoma.[7] Glaucoma occurs in up to 50% of patients with Rieger syndrome. Glaucoma develops during adolescence or late childhood, but often occurs in infancy.[8][10] In addition, a prominent Schwalbe's line, an opaque ring around the cornea known as posterior embryotoxon, may arise with hypoplasia of the iris.[5] Below average height and stature, stunted development of the mid-facial features and mental deficiencies may also be observed in patients.[5]

See also[edit | edit source]

References[edit | edit source]

  1. , Missed case of Axenfeld-Rieger syndrome: a case report, Cases Journal, 2008, Vol. 1(Issue: 1), pp. 299, DOI: 10.1186/1757-1626-1-299, PMID: 18990239, PMC: 2585579,
  2. , Identification of four new PITX2 gene mutations in patients with Axenfeld-Rieger syndrome, Molecular Vision, 2006, Vol. 12 pp. 1448–60, PMID: 17167399, Full text,
  3. , The Axenfeld syndrome and the Rieger syndrome, Journal of Medical Genetics, 1978, Vol. 15(Issue: 1), pp. 30–4, DOI: 10.1136/jmg.15.1.30, PMID: 416212, PMC: 1012820,
  4. 4.0 4.1 Axenfeld-Rieger syndrome type 1 Full text, , National Center for Biotechnology Information,
  5. 5.0 5.1 5.2 , Case of chromosome 6p25 terminal deletion associated with Axenfeld–Rieger syndrome and persistent hyperplastic primary vitreous, American Journal of Medical Genetics Part A, 2006, Vol. 140(Issue: 5), pp. 503–8, DOI: 10.1002/ajmg.a.31085, PMID: 16470791,
  6. , Axenfeld-Rieger anomaly and Axenfeld-Rieger syndrome: Clinical, molecular-cytogenetic, and DNA array analyses of three patients with chromosomal defects at 6p25, American Journal of Medical Genetics Part A, 2011, Vol. 155A(Issue: 12), pp. 2925–32, DOI: 10.1002/ajmg.a.33858, PMID: 22009788,
  7. 7.0 7.1 7.2 , Morphology of the sella turcica in Axenfeld-Rieger syndrome with PITX2 mutation, Journal of Oral Pathology & Medicine, 2008, Vol. 37(Issue: 8), pp. 504–10, DOI: 10.1111/j.1600-0714.2008.00650.x, PMID: 18331556,
  8. 8.0 8.1 8.2 , Embryotoxon cornea posterius, Berichte der Deutschen Ophthalmologischen Gesellschaft, 1920, Vol. 42 pp. 301–2,
  9. Salmon, Kanski's clinical ophthalmology : a systematic approach, 9th edition, Edinburgh:Elsevier, 2020, ISBN 978-0-7020-7713-5,
  10. 10.0 10.1 10.2 , Absence of PITX2, BARX1, and FOXC1 mutations in De Hauwere syndrome (Axenfeld–Rieger anomaly, hydrocephaly, hearing loss): A 25-year follow up, American Journal of Medical Genetics Part A, 2007, Vol. 143A(Issue: 11), pp. 1227–30, DOI: 10.1002/ajmg.a.31732, PMID: 17486624,
  11. , Genetics of anterior segment dysgenesis disorders., Current Opinion in Ophthalmology, Vol. 22(Issue: 5), pp. 314–24, DOI: 10.1097/ICU.0b013e328349412b, PMID: 21730847, PMC: 3558283,
  12. 12.0 12.1 Axenfeld-Rieger syndrome Full text, , United States Department of Health and Human Services, November 8, 2016,
  13. 13.0 13.1 , A second locus for Rieger syndrome maps to chromosome 13q14, American Journal of Human Genetics, 1996, Vol. 59(Issue: 3), pp. 613–9, PMID: 8751862, PMC: 1914897,
  14. How are genetic conditions diagnosed? Full text, , United States Department of Health and Human Services, November 8, 2016,
  15. synd/1284 at Who Named It?

Further reading[edit | edit source]

,

 The Molecular Mechanisms of Axenfeld-Rieger Syndrome, 
  
 Springer, 
 2005, 
 Series: Medical Intelligence Unit, 
  
 ISBN 978-0-387-28672-3, 
 DOI: 10.1007/0-387-28672-1,

,

 Textbook of Ophthalmology, 
  
 Jaypee Brothers, 
 2002, 
  
  
 ISBN 978-81-7179-884-1, 
  
  
  
 Pages: 1049–51,

,

 Axenfeld-Rieger syndrome. A spectrum of developmental disorders, 
 Survey of Ophthalmology, 
 1985, 
 Vol. 29(Issue: 6), 
 pp. 387–409, 
 DOI: 10.1016/0039-6257(85)90205-X, 
 PMID: 3892740,

,

 Axenfeld-Rieger syndrome in the age of molecular genetics, 
 American Journal of Ophthalmology, 
 2000, 
 Vol. 130(Issue: 1), 
 pp. 107–15, 
 DOI: 10.1016/S0002-9394(00)00525-0, 
 PMID: 11004268,


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