Abstract
A macrodactilia, um crescimento excessivo e anormal de um ou mais dedos da mão ou do pé, é uma malformação congênita rara (cerca de 0,08 por 10.000 nascidos vivos) que causa importantes prejuízos funcionais e estéticos. Com o objetivo de identificar as mutações genéticas causadoras e relacioná-las com as manifestações fenotípicas da macrodactilia, este estudo realizou uma revisão integrativa da literatura científica recente. A metodologia focou na busca por artigos entre 2014 e 2024 que relacionassem a macrodactilia a mutações gênicas descritas na literatura, com ênfase nos genes PIK3CA e AKT1. Dos 92 artigos inicialmente encontrados, 15 foram incluídos na análise. Os resultados destacaram o gene PIK3CA como o mais frequentemente mutado (em 12 dos 15 artigos), seguido por AKT1, PTEN, NPR3, NPR2 e PIK3R1. As mutações mais comuns no PIK3CA foram p.Glu542Lys, p.Glu545Lys e p.His1047Arg, conhecidas como "hot spots" que promovem o aumento da função da proteína PI3K e o supercrescimento. Essas alterações no PIK3CA ativam a via PIK3CA-AKT-mTOR, central para a proliferação celular, e se enquadram no espectro de supercrescimento relacionado ao PIK3CA (PROS). As mutações foram correlacionadas tanto com a macrodactilia isolada quanto com síndromes como CLOVES e MCAP. O estudo concluiu que o gene PIK3CA é o principal locus alterado na patologia. No entanto, a alta variabilidade genótipo-fenótipo dificulta o diagnóstico e prognóstico, ressaltando a importância de mais estudos futuros e pesquisas sobre inibidores da via PI3K-AKT-mTOR para novas opções terapêuticas.
References
- BECKER, J. et al. PIK3CA Mutational Analysis in Patients With Macrodactyly. Pediatric and Developmental Pathology, [S. l.], v. 25, n. 6, p. 556-564, nov./dez. 2022.
- BLACKBURN, P. R. et al. PIK3CA mutations in lipomatosis of nerve with or without nerve territory overgrowth. Modern Pathology, [S. l.], v. 33, p. 1261–1271, 2019.
- CARTY, M. J.; TAGHINIA, A.; UPTON, J. Overgrowth conditions: a diagnostic and therapeutic conundrum. Hand Clinics, [S. l.], v. 25, n. 2, p. 229-245, maio 2009.
- CASTRO, G. R. S. de et al. Pediatric macrodactyly: a case report. International Journal of Health Science, v. 4, n. 66, p. 2-5, 2024.
- COTTRELL, C. E. et al. Somatic PIK3R1 variation as a cause of vascular malformations and overgrowth. Genetics in Medicine, [S. l.], v. 23, n. 8, p. 1568-1577, maio 2021.
- CUI, H. et al. Activating PIK3CA mutation promotes osteogenesis of bone marrow mesenchymal stem cells in macrodactyly. Cell Death & Disease, [S. l.], v. 11, n. 505, 2020. Disponível em: https://doi.org/10.1038/s41419-020-2723-6. Acesso em: 1 fev. 2025.
- Da COSTA, J. N.; MATIAS, J. Segmental Hemihyperplasia-Related Macrodactyly with Congenital Renal Agenesis: A Hand Surgeon's Point of View. Archives of Plastic Surgery, v. 42, n. 5, p. 655-658, 2015. DOI: 10.5999/aps.2015.42.5.655.
- ENGELMAN, J. A.; LUO, J.; CANTLEY, L. C. The evolution of phosphatidylinositol 3-kinases as regulators of growth and metabolism. Nature Reviews Genetics, Londres, v. 7, n. 8, p. 606-619, ago. 2006.
- EZAKI, M. Insights into the pathogenesis of macrodactyly. The Journal of Hand Surgery, European Volume, v. 44, n. 1, p. 25-31, 2019. DOI: 10.1177/1753193418790928.
- GISHEN, K.; ASKARI, M. Congenital Hand Anomalies: Etiology, Classification, and Treatment. Journal of Craniofacial Surgery, Philadelphia, v. 25, n. 1, p. 284-294, jan. 2014.
- GIZEWSKA-KACPRZAK, K. et al. Macrodactyly. Children, Basel, v. 11, n. 7, p. 753, 2024.
- JACOBS, C. J. et al. Surgical management for isolated macrodactyly in an adult PIK3CA mutant. JPRAS Open, [S. l.], v. 26, p. 86–90, 2020.
- JURCĂ, M. C. et al. Congenital anomalies of digits - a clinical-epidemiological study of 301 patients. Romanian Journal of Morphology and Embryology, [S. l.], v. 60, n. 4, p. 1221-1226, 2019.
- KALEN, V.; BURWELL, D. S.; OMER, G. E. Macrodactyly of the Hands and Feet. Journal of Pediatric Orthopaedics, Baltimore, v. 8, n. 3, p. 311-315, maio/jun. 1988.
- KEPPLER-NOREUIL, K. M. et al. Clinical Delineation and Natural History of the PIK3CA-Related Overgrowth Spectrum. American Journal of Medical Genetics, Part A, [S. l.], v. 164A, n. 7, p. 1713-1733, jul. 2014.
- LAUFFER, P. et al. Broadening the Spectrum of Loss-of-Function Variants in NPR-C-Related Extreme Tall Stature. Journal of the Endocrine Society, [S. l.], v. 6, n. 4, 2022.
- LI, J. F.; TIAN, G. L.; PAN, H.; ZHANG, W. T.; LI, D. C.; LIU, J. D.; ZHAO, L.; LI, H. L. An analysis of pathogenic genes and mutation sites of macrodactyly. Pharmacogenomics and Personalized Medicine, v. 15, p. 55–64, 2022. Disponível em: https://doi.org/10.2147/PGPM.S346373. Acesso em: 01/02/2025.
- LOCONTE, D. C. et al. Molecular and Functional Characterization of Three Different Postzygotic Mutations in PIK3CA-Related Overgrowth Spectrum (PROS) Patients: Effects on PI3K/AKT/mTOR Signaling and Sensitivity to PI3K Inhibitors. PLOS One, [S. l.], v. 10, n. 4, p. e0123092, 27 abr. 2015.
- MIRZAA, G. M. et al. PIK3CA-associated developmental disorders exhibit distinct classes of mutations with variable expression and tissue distribution. JCI Insight, Ann Arbor, v. 1, n. 9, p. 1-14, 16 jun. 2016.
- MIURA, K. et al. Overgrowth Syndrome Associated With a Gain-of-Function Mutation of the Natriuretic Peptide Receptor 2 (NPR2) Gene. American Journal of Medical Genetics, Part A, [S. l.], v. 164A, n. 1, p. 156-163, jan. 2014.
- MORIN, G. et al. Treatment of two infants with PIK3CA-related overgrowth spectrum by alpelisib. Journal of Experimental Medicine, New York, v. 219, n. 3, p. e20212148, 7 mar. 2022.
- RIOS, J. J. et al. Somatic gain-of-function mutations in PIK3CA in patients with macrodactyly. Human Molecular Genetics, Oxford, v. 22, n. 3, p. 444–451, 2013.
- SUN, B. et al. Activating PIK3CA mutation promotes adipogenesis of adipose-derived stem cells in macrodactyly via up-regulation of E2F1. Cell Death & Disease, [S. l.], v. 11, n. 600, 2020. Disponível em: https://doi.org/10.1038/s41419-020-02806-1.
- TIAN, W. et al. Phenotypic and genetic spectrum of isolated macrodactyly: somatic mosaicism of PIK3CA and AKT1 oncogenic variants. Orphanet Journal of Rare Diseases, [S. l.], v. 15, n. 288, 2020.
- TRIPOLSZKI, K. et al. Somatic mosaicism of the PIK3CA gene identified in a Hungarian girl with macrodactyly and syndactyly. European Journal of Medical Genetics, [S. l.], v. 59, n. 4, p. 223-226, abr. 2016.
- UDOMCHAIPRASERTKUL, W. et al. A somatic PIK3CA p.H1047L mutation in a Thai patient with isolated macrodactyly: a case report. Orphanet Journal of Rare Diseases, [S. l.], v. 14, n. 219, p. 1-6, 11 set. 2019.
- WU, J. et al. Clinical Characteristics of 90 Macrodactyly Cases. Journal of Hand Surgery, New York, v. 45, n. 6, p. e1-e5, jun. 2020.
- YEUNG, K. S. et al. Somatic PIK3CA mutations in seven patients with PIK3CA-related overgrowth spectrum. American Journal of Medical Genetics Part A, [S. l.], v. 173A, n. 4, p. 978-984, 2017.
- ZHAO, L.; VOGT, P. K. Class I PI3K in oncogenic cellular transformation. Oncogene, Londres, v. 27, n. 41, p. 5486-5496, 2008.