TY - JOUR T1 - Phenotype characterisation of <em>TBX4</em> mutation and deletion carriers with neonatal and paediatric pulmonary hypertension JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.01965-2018 VL - 54 IS - 2 SP - 1801965 AU - Csaba Galambos AU - Mary P. Mullen AU - Joseph T. Shieh AU - Nicolaus Schwerk AU - Matthew J. Kielt AU - Nicola Ullmann AU - Renata Boldrini AU - Irena Stucin-Gantar AU - Cristina Haass AU - Manish Bansal AU - Pankaj B. Agrawal AU - Joyce Johnson AU - Donatella Peca AU - Cecilia Surace AU - Renato Cutrera AU - MichaelĀ W. Pauciulo AU - William C. Nichols AU - Matthias Griese AU - Dunbar Ivy AU - Steven H. Abman AU - Eric D. Austin AU - Olivier Danhaive Y1 - 2019/08/01 UR - http://erj.ersjournals.com/content/54/2/1801965.abstract N2 - Rare variants in the T-box transcription factor 4 gene (TBX4) have recently been recognised as an emerging cause of paediatric pulmonary hypertension (PH). Their pathophysiology and contribution to persistent pulmonary hypertension in neonates (PPHN) are unknown. We sought to define the spectrum of clinical manifestations and histopathology associated with TBX4 variants in neonates and children with PH.We assessed clinical data and lung tissue in 19 children with PH, including PPHN, carrying TBX4 rare variants identified by next-generation sequencing and copy number variation arrays.Variants included six 17q23 deletions encompassing the entire TBX4 locus and neighbouring genes, and 12 likely damaging mutations. 10 infants presented with neonatal hypoxic respiratory failure and PPHN, and were subsequently discharged home. PH was diagnosed later in infancy or childhood. Three children died and two required lung transplantation. Associated anomalies included patent ductus arteriosus, septal defects, foot anomalies and developmental disability, the latter with a higher prevalence in deletion carriers. Histology in seven infants showed abnormal distal lung development and pulmonary hypertensive remodelling.TBX4 mutations and 17q23 deletions underlie a new form of developmental lung disease manifesting with severe, often biphasic PH at birth and/or later in infancy and childhood, often associated with skeletal anomalies, cardiac defects, neurodevelopmental disability and other anomalies.TBX4 mutations and deletions are associated with abnormal distal lung development, persistent pulmonary hypertension of the newborn, paediatric pulmonary hypertension, multiple congenital anomalies and developmental disabilities http://bit.ly/2UXDrl3 ER -