For Medical Professionals

Baylor Genetics
FOXF1 – Related Disorders

Baylor College of Medicine
Clinical Trial – Genetic and Rare Diseases – Observational and Gene Discovery:
Molecular Genetics of Alveolar Capillary Dysplasia With Misalignment of Pulmonary Veins (ACDMPV) (H-8712)
*Currently Enrolling*

We demonstrated that haploinsufficiency of the transcriptional factor FOXF1 gene on 16q24.1 results in a lethal neonatal diffuse lung developmental disorder alveolar capillary dysplasia with misalignment of pulmonary veins. Infants affected with ACDMPV develop severe respiratory distress with pulmonary hypertension within the first two days of life and despite of intensive care die within first few days of life. We investigate the role of lncRNAs in a long range regulation of FOXF1 expression.

Postmortem genetic testing of the FOXF1 gene in the infant’s blood or lung autopsy or biopsy sample and parents’ blood samples will be performed on a research basis after the initial ACDMPV diagnosis is verified by an experienced pathologist at Texas Children’s Hospital in Houston. First it’s important to speak to your pathologist or physician so that your infant’s samples can be sent to Baylor College of Medicine. Your medical team should be able to coordinate this for you.

The samples and information required are:

1. A lung biopsy or autopsy sample of lung tissue. These can be sent as slides (stained or unstained) and/or formalin fixed paraffin embedded (FFPE) lung tissue block.

2. The local pathology report of the lung biopsy or autopsy, if available.

3. Your infant’s blood (if stored in +4C fridge) or isolated blood DNA (blood sample containing only genetic material) in EDTA tubes (purple top) if available. If a blood sample is not available frozen lung tissue can also be used to obtain DNA.

4. Completed and signed consent forms.

Contact Information:

Pawel Stankiewicz, M.D., Ph.D.
Associate Professor
Department of Molecular & Human Genetics
Baylor College of Medicine
One Baylor Plaza, Room ABBR-R809
Houston TX, 77030
Phone: (713) 798-5370
Fax: (713) 798-7418
Email: pawels@bcm.edu

In addition to the samples requested above, consider also providing other tissue (i.e. liver, stomach or intestine), to be preserved frozen along with paraffin embedded.

At a minimum, for babies with imminent death with one or more anomalies where ACDMPV is suspected, offer the option of DNA blood banking in the event that a possible genetic/inherited diagnosis is reached on autopsy and additional genetic testing may be warranted for genetic counseling purposes. A blood sample for genetic testing can be collected prior to or after an infant is placed on ECMO as the donor blood used for ECMO is depleted of the white blood cells that are used in genetic testing before it is given to the infant and therefore there is no chance of contamination.

Bilateral Lung Transplantation:

St. Louis Children’s Hospital in St. Louis, Missouri, United States, has the most active pediatric lung transplant program in the world. According to a 2013 case series conducted by St. Louis, “If they survive to bilateral lung transplantation (BLT), patients with ACDMPV can have successful outcomes” and the ACDMPV patients “are alive at last follow-up at 1, 8, 9 and 12 years of age” (as of May 2013). A 2017 update case study found similar results, “The 1- and 5-year survival rates for infants with atypical ACDMPV are similar to infants transplanted for other indications.” See Infants with Atypical Presentations of Alveolar Capillary Dysplasia with Misalignment of the Pulmonary Veins Who Underwent Bilateral Lung Transplantation. Towe CT, White FV, Grady RM, Sweet SC, Eghtesady P, Wegner DJ, Sen P, Szafranski P, Stankiewicz P, Hamvas A, Cole FS, Wambach JA (2017): In: J Pediatr. 2017 Nov 30. pii: S0022-3476(17)31375-6. doi: 10.1016/j.jpeds.2017.10.026.

In addition, St. Louis worked closely with a family diagnosed prenatally at 18 weeks that relocated to St. Louis in spring 2018 in the hopes it would ultimately be the ACDA’s first prenatal diagnosis to transplant case. Unfortunately, there were unforeseen complications and the infant passed away shortly after birth.

Children’s Hospital of Philadelphia (CHOP) in Philadelphia, Pennsylvania, United States, successfully performed a bilateral lung transplant on an ACDMPV patient at four months old in November 2016. CHOP accepted a second ACDMPV patient (transferred from Children’s Hospital of Wisconsin) that sadly passed away at ten months old in July 2017 while waiting for a match on the lung transplant list. CHOP also worked extensively to coordinate the intended transfer of a third ACDMPV patient from Children’s Hospital Los Angeles for lung transplant consideration in July 2018.

Cincinnati Children’s Hospital Medical Center in Cincinnati, Ohio, United States, successfully performed at least two bilateral lung transplants.

Great Ormond Street Hospital in London, England, United Kingdom performed a successful bilateral lung transplant on an ACDMPV patient at five months old in May 2016, which at the time was the youngest child to receive a bilateral lung transplant in the UK.

A German hospital performed a bilateral lung transplant on an ACDMPV patient at two years old in December 2018.

Contacts:

1) Dr. Pawel Stankiewicz is the lead supervising researcher in ACDMPV at Baylor College of Medicine in Houston and the first contact for questions about ACDMPV genetic testing.

2) Dr. Przemyslaw Szafranski is a lead member of the ACDMPV research team at Baylor College of Medicine in Houston.

3) Dr. Christopher Towe at Cincinnati Children’s Hospital Medical Center.

4) Dr. Vladimir Kalinichenko at Cincinnati Children’s Hospital Medical Center.

5) Dr. Csaba Galambos at Children’s Hospital Colorado and University of Colorado Denver.

6) Dr. Aaron Hamvas at Northwestern University Feinberg School of Medicine.

7) Dr. Partha Sen formerly of Baylor College of Medicine and Northwestern University Feinberg School of Medicine.