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Clinical and Genetic Characteristics of Noonan Syndrome and Noonan-like Diseases

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Abstract

Noonan syndrome (NS) is a group of inherited autosomal dominant diseases characterized by a disturbance of the RAS-MAPK signaling pathway and leading to various clinical manifestations. The prevalence in the world is estimated at 1–2 per 20 000 newborns. The review discusses the molecular genetic causes of the disease, the characteristics of the clinical manifestations of the disease, and the methods of molecular genetic diagnosis.

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REFERENCES

  1. Tartaglia, M., Kalidas, K., Shaw, A., et al., PTPN11 mutations in Noonan syndrome: molecular spectrum, genotype—phenotype correlation, and phenotypic heterogeneity, Am. J. Hum. Genet., 2002, vol. 70, pp. 1555—1563.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Noonan, J.A., Hypertelorism with Turner phenotype: a new syndrome with associated congenital heart disease, Am. J. Dis. Child., 1968, vol. 116, pp. 373—380.

    Article  CAS  PubMed  Google Scholar 

  3. Celermajer, J.M., Bowdler, J.D., and Cohen, D.H., Pulmonary stenosis in patients with the Turner phenotype in the male, Am. J. Dis. Child., 1968, vol. 116, pp. 351—358.

    CAS  PubMed  Google Scholar 

  4. Nora, J.J., Nora, A.H., Sinha, A.K., et al., The Ullrich—Noonan syndrome (Turner phenotype), Am. J. Dis. Child., 1974, vol. 127, pp. 48—55.

    CAS  PubMed  Google Scholar 

  5. Tartaglia, M., Mehler, E.L., Goldberg, R., et al., Mutations in PTPN11, encoding the protein tyrosine phosphatase SHP-2, cause Noonan syndrome, Nat. Genet., 2001, vol. 29, pp. 465—468.

    Article  CAS  PubMed  Google Scholar 

  6. Romano, A.A., Allanson, J.E., Dahlgren, J., et al., Noonan syndrome: clinical features, diagnosis, and management guidelines, Pediatrics, 2010, vol. 126, pp. 746—759. https://doi.org/10.1542/peds.2009-3207

    Article  PubMed  Google Scholar 

  7. Tartaglia, M., Zampino, G., and Gelb, B.D., Noonan syndrome: clinical aspects and molecular pathogenesis, Mol. Syndromol., 2010, vol. 1, pp. 2—26. https://doi.org/10.1159/000276766

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Lepri, F.R., Scavelli, R., Digilio, M.C., et al., Diagnosis of Noonan syndrome and related disorders using target next generation sequencing, BMC Med. Genet., 2014, vol. 15, p. 14. https://doi.org/10.1186/1471-2350-15-14

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Tidyman, W.E. and Rauen, K.A., The RASopathies: developmental syndromes of RAS/MAPK pathway dysregulation, Curr. Opin. Genet. Dev., 2009, vol. 19, pp. 230—236.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Bezniakow, N. and Gos, M.O.E., The rasopathies as an example of RAS/MAPK pathway disturbances—clinical presentation and molecular pathogenesis of selected syndromes, Dev. Period. Med., 2014, vol. 18, pp. 285—296.

    PubMed  Google Scholar 

  11. Schubbert, S., Shannon, K., and Bollag, G., Hyperactive RAS in developmental disorders and cancer, Nat. Rev. Cancer, 2007, vol. 7, pp. 295—308.

    Article  CAS  PubMed  Google Scholar 

  12. van der Burgt, I., Berends, E., Lommen, E., et al., Clinical and molecular studies in a large Dutch family with Noonan syndrome, Am. J. Med. Genet., 1994, vol. 53, pp. 187—191.

    Article  CAS  PubMed  Google Scholar 

  13. Yoshida, R., Hasegawa, T., Hasegawa, Y., et al., Protein—tyrosine phosphatase, nonreceptor type 11 mutation analysis and clinical assessment in 45 patients with Noonan syndrome, J. Clin. Endocrinol. Metab., 2004, vol. 89, pp. 3359—3364.

    Article  CAS  PubMed  Google Scholar 

  14. Zenker, M., Buheitel, G., Rauch, R., et al., Genotype—phenotype correlations in Noonan syndrome, J. Pediatr., 2004, vol. 144, pp. 368—374.

    Article  CAS  PubMed  Google Scholar 

  15. Jongmans, M., Otten, B., Noordam, K., et al., Genetics and variation in phenotype in Noonan syndrome, Horm. Res., 2004, vol. 62, suppl. 3, pp. 56—59.

    CAS  PubMed  Google Scholar 

  16. Bhambhani, V. and Muenke, M., Noonan syndrome, Am. Fam. Physician, 2014, vol. 89, pp. 37—43.

    PubMed  PubMed Central  Google Scholar 

  17. Gelb, B.D. and Tartaglia, M., Noonan syndrome with multiple lentigines, GeneReviews NCBI, 1993.

    Google Scholar 

  18. Abdel-Salam, E. and Temtamy, S.A., Familial Turner phenotype, J. Pediatr., 1969, vol. 74, pp. 67—72.

    Article  CAS  PubMed  Google Scholar 

  19. Maximilian, C., Ioan, D.M., and Fryns, J.P., A syndrome of mental retardation, short stature, craniofacial anomalies with palpebral ptosis and pulmonary stenosis in three siblings with normal parents: an example of autosomal recessive inheritance of the Noonan phenotype? Genet. Couns., 1992, vol. 3, pp. 115—118.

    CAS  PubMed  Google Scholar 

  20. van Der Burgt, I. and Brunner, H., Genetic heterogeneity in Noonan syndrome: evidence for an autosomal recessive form, Am. J. Med. Genet., 2000, vol. 94, pp. 46—51.

    Article  CAS  PubMed  Google Scholar 

  21. Roberts, A.E., Allanson, J.E., Tartaglia, M., et al., Noonan syndrome, Lancet, 2013, vol. 381, pp. 333—342. https://doi.org/10.1016/S0140-6736(12)61023-X

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Jorge, A.A.L., Malaquias, A.C., Arnhold, I.J.P., et al., Noonan syndrome and related disorders: a review of clinical features and mutations in genes of the RAS/MAPK pathway, Horm. Res., 2009, vol. 71, pp. 185—193.

    CAS  PubMed  Google Scholar 

  23. Zenker, M., Lehmann, K., Schulz, A.L., et al., Expansion of the genotypic and phenotypic spectrum in patients with KRAS germline mutations, J. Med. Genet., 2007, vol. 44, pp. 131—135.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Kratz, C.P., Zampino, G., Kriek, M., et al., Craniosynostosis in patients with Noonan syndrome caused by germline KRAS mutations, Am. J. Med. Genet, Part A, 2009, vol. 149A, pp. 1036—1040.

    Article  CAS  Google Scholar 

  25. Friday, B.B. and Adjei, A.A., K-ras as a target for cancer therapy, Biochim. Biophys. Acta, 2005, vol. 1756, pp. 127—144.

    CAS  PubMed  Google Scholar 

  26. Plowman, S.J., Williamson, D.J., O’Sullivan M.J., et al., While K-ras is essential for mouse development, expression of the K-ras 4A splice variant is dispensable, Mol. Cell Biol., 2003, vol. 23, pp. 9245—9250.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Zenker, M., Horn, D., Wieczorek, D., et al., SOS1 is the second most common Noonan gene, but plays no major role in cardio-facio-cutaneous syndrome, J. Med. Genet., 2007, vol. 44, pp. 651—656.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Tartaglia, M., Pennacchio, L.A., Zhao, C., et al., Gain-of-function SOS1 mutations cause a distinctive form of Noonan syndrome, Nat. Genet., 2007, vol. 39, pp. 75—79.

    Article  CAS  PubMed  Google Scholar 

  29. Pierpont, E.I., Pierpont, M.E., Mendelsohn, N.J., et al., Genotype differences in cognitive functioning in Noonan syndrome, Genes Brain Behav., 2009, vol. 8, pp. 275—282.

    Article  CAS  PubMed  Google Scholar 

  30. Egan, S.E. and Weinberg, R.A., The pathway to signal achievement, Nature, 1993, vol. 365, pp. 781—783.

    Article  CAS  PubMed  Google Scholar 

  31. Takai, Y., Sasaki, T., and Matozaki, T., Small GTP-binding proteins, Physiol. Rev., 2001, vol. 81, pp. 153—208.

    Article  CAS  PubMed  Google Scholar 

  32. Roberts, A.E., Araki, T., Swanson, K.D., et al., Germline gain-of-function mutations in SOS1 cause Noonan syndrome, Nat. Genet., 2007, vol. 39, pp. 70—74.

    Article  CAS  PubMed  Google Scholar 

  33. Lepri, F., De Luca, A., Stella, L., et al., SOS1 mutations in Noonan syndrome: molecular spectrum, structural insights on pathogenic effects, and genotype—phenotype correlations, Hum. Mutat., 2011, vol. 32, pp. 760—772.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Wellbrock, C., Karasarides, M., and Marais, R., The RAF proteins take centre stage, Nat. Rev. Mol. Cell Biol., 2004, vol. 5, pp. 875—885.

    Article  CAS  PubMed  Google Scholar 

  35. Leicht, D.T., Balan, V., Kaplun, A., et al., Raf kinases: function, regulation and role in human cancer, Biochim. Biophys. Acta, 2007, vol. 1773, pp. 1196—1212.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Cirstea, I.C., Kutsche, K., Dvorsky, R., et al., A restricted spectrum of NRAS mutations causes Noonan syndrome, Nat. Genet., 2010, vol. 42, pp. 27—29.

    Article  CAS  PubMed  Google Scholar 

  37. Denayer, E., Peeters, H., Sevenants, L., et al., NRAS mutations in Noonan syndrome, Mol. Syndromol., 2012, vol. 3, pp. 34—38.

    CAS  PubMed  PubMed Central  Google Scholar 

  38. Sarkozy, A., Carta, C., Moretti, S., et al., Germline BRAF mutations in Noonan, LEOPARD, and cardiofaciocutaneous syndromes: molecular diversity and associated phenotypic spectrum, Hum. Mutat., 2009, vol. 30, pp. 695—702.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Nystrom, A.M., Ekvall, S., Berglund, E., et al., Noonan and cardio-facio-cutaneous syndromes: two clinically and genetically overlapping disorders, J. Med. Genet., 2008, vol. 45, pp. 500—506.

    Article  PubMed  CAS  Google Scholar 

  40. Aoki, Y., Niihori, T., Banjo, T., et al., Gain-of-function mutations in RIT1 cause Noonan syndrome, a RAS/MAPK pathway syndrome, Am. J. Hum. Genet., 2013, vol. 93, pp. 173—180.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Yamamoto, G.L., Aguena, M., Gos, M., et al., Rare variants in SOS2 and LZTR1 are associated with Noonan syndrome, J. Med. Genet., 2015, vol. 52, pp. 413—421.

    Article  CAS  PubMed  Google Scholar 

  42. Wang, D.Z., Hammond, V.E., Abud, H.E., et al., Mutation in Sos1 dominantly enhances a weak allele of the EGFR, demonstrating a requirement for Sos1 in EGFR signaling and development, Genes Dev., 1997, vol. 11, pp. 309—320.

    Article  CAS  PubMed  Google Scholar 

  43. Johnston, J.J., van der Smagt, J.J., Rosenfeld, J.A., et al., Autosomal recessive Noonan syndrome associated with biallelic LZTR1 variants, Genet. Med., 2018, pp. 1—11. https://doi.org/10.1038/gim.2017.249

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Nisbet, D.L., Griffin, D.R., and Chitty, L.S., Prenatal features of Noonan syndrome, Prenat. Diagn., 1999, vol. 19, pp. 642—647.

    Article  CAS  PubMed  Google Scholar 

  45. Maheshwari, M., Belmont, J., Fernbach, S., et al., PTPN11 mutations in Noonan syndrome type I: detection of recurrent mutations in exons 3 and 13, Hum. Mutat., 2002, vol. 20, pp. 298—304.

    Article  CAS  PubMed  Google Scholar 

  46. Tafazoli, A., Eshraghi, P., Koleti, Z.K., et al., Noonan syndrome—a new survey, Arch. Med. Sci., 2017, vol. 13, pp. 215—222.

    Article  PubMed  Google Scholar 

  47. Hafner, C. and Groesser, L., Mosaic RASopathies, Cell Cycle, 2013, vol. 12, pp. 43—50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Siegel, D.H., McKenzie, J., Frieden, I.J., et al., Dermatological findings in 61 mutation-positive individuals with cardiofaciocutaneous syndrome, Br. J. Dermatol., 2011, vol. 164, pp. 521—529.

    CAS  PubMed  PubMed Central  Google Scholar 

  49. Rauen, K.A., NIH public access, Annu. Rev. Genomics Hum. Genet., 2013, pp. 355—369.

  50. Gripp, K.W. and Lin, A.E., Costello syndrome, GeneReviews NCBI, 1993. https://www.ncbi.nlm.nih.gov/books/NBK1507/.

  51. Smith, L.P., Podraza, J., and Proud, V.K., Polyhydramnios, fetal overgrowth, and macrocephaly: prenatal ultrasound findings of Costello syndrome, Am. J. Med. Genet., Part A, 2009, vol. 149A, pp. 779—784.

    Article  Google Scholar 

  52. Siegel, D.H., Mann, J.A., Krol, A.L., et al., Dermatological phenotype in Costello syndrome: consequences of RAS dysregulation in development, Br. J. Dermatol., 2012, vol. 166, pp. 601—607.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Boyd, K.P., Korf, B.R., and Theos, A., Neurofibromatosis type 1, J. Am. Acad. Dermatol., 2009, vol. 61, pp. 1—6.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Friedman, J.M., Neurofibromatosis 1, GeneReviews NCBI, 1993. https://www.ncbi.nlm.nih.gov/books/ NBK1109/.

  55. Abramowicz, A. and Gos, M., Neurofibromin in neurofibromatosis type 1—mutations in NF1gene as a cause of disease, Dev. Period Med., 2014, vol. 18, pp. 297—306.

    PubMed  Google Scholar 

  56. Curto, M. and McClatchey, A.I., Nf2/Merlin: a coordinator of receptor signalling and intercellular contact, Br. J. Cancer, 2008, vol. 98, pp. 256—262.

    Article  CAS  PubMed  Google Scholar 

  57. Writzl, K., Hoovers, J., Sistermans, E.A., et al., LEOPARD syndrome with partly normal skin and sex chromosome mosaicism, Am. J. Med. Genet., Part A, 2007, vol. 143A, pp. 2612—2615.

    Article  Google Scholar 

  58. Tartaglia, M., Gelb, B.D., and Zenker, M., Noonan syndrome and clinically related disorders, Best Pract. Res. Clin. Endocrinol. Metab., 2011, vol. 25, pp. 161—179.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. https://portal.biobase-international.com/hgmd/pro/.

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This work was performed as part of the state task of the Ministry of Education and Science of Russia.

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Correspondence to A. A. Orlova.

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The authors declare that they have no conflict of interest. This study does not contain any research involving humans or animals as research objects.

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Orlova, A.A., Dadali, E.L. & Polyakov, A.V. Clinical and Genetic Characteristics of Noonan Syndrome and Noonan-like Diseases. Russ J Genet 56, 540–547 (2020). https://doi.org/10.1134/S1022795420050117

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