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Beckwith-Wiedemann syndrome

Written2000-11Marcel Mannens
DNA-diagnostics laboratory, University of Amsterdam, Academic Medical Center Department of Clinical Genetics PO Box 22700 1100 DE Amsterdam, the Netherlands

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Other namesExomphalos-macroglossia-gigantism triad
Atlas_Id 10037
Genes implicated inCDKN1C  H19  ICR1  TGM1  IGF2  KCNQ1OT1  NSD1  ZNF215  
Inheritance incidence of 7/105; given the variable expression of the symptoms, the actual frequency is likely to be higher; generally there is sporadic occurrence of the syndrome (85%); inheritance is mostly maternal (imprinting) with a more severe phenotype after maternal transmission


Note clinically and genetically heterogeneous; three distinct regions on 11p15 have been associated with BWS (BWSCR1/2/3); BWSCR2 seems to be particularly associated with hemihypertrophy
Phenotype and clinics multiple features that occur variably; most prominent is the EMG triad (exomphalos-macroglossia-gigantism): apart from the abdominal wall defects and pre- and postnatal growth abnormalities, earlobe pits or creases, facial nevus flammeus, hypoglycemia, renal abnormalities and hemihypertrophy (unilateral overgrowth) are frequently seen
Neoplastic risk the increased risk for childhood solid tumours is 7.5% (thousand fold increase); tumours most frequently seen are nephroblastoma (Wilms tumour), adrenocortical carcinoma, rhabdomyosarcoma and hepatoblastoma; clinical risk factors are hemihypertrophy and nephromegaly; genetic risk factors are uniparental disomy (UPD) and H19/IGF2 imprinting defects
Treatment in general surgical correction of the abdominal wall defects and macroglossia; monitoring the glycemia during the first 3 days and early treatment of hypoglycemia (deleterious for central nervous system) is of importance to avoid further complications; frequent screening for tumour development
Prognosis clinical features tend to become less with ageing; tumour risk decreases strongly after the 4-7th year of birth


Inborn conditions paternal duplications of chromosome region 11p15, maternal translocations involving chromosome region 11p15.3-p15.5
Cytogenetics of cancer apart from chromosome 11 aberrations, multiple chromosomes are involved in tumour development; promising prognostic indicators in Wilms tumour might be chromosome 1p and 16q aberrations; tther molecular abnormalities associated with an adverse outcome in Wilms tumour are 22q allele loss or P53 aberrations

Other findings

Note in 10-20% of BWS cases, uniparental disomy of chromosome region 11p15 is seen, mostly in a mosaic form

Genes involved and Proteins

Gene NameH19
Alias D11S813E, D11S878E, ASM, ASM1
Location 11p15.5
Note imprinted, maternally expressed, untranslated mRNA
Description the human H19 gene is 2.7 kb long and includes 4 small introns; maternally expressed, paternal imprint
Description untranslated
Expression highly expressed in endodermal and mesodermal embryonic tissues; in adult brain, only in the pons and globus pallidus; in adult tissues, expression is primarily confined to skeletal and cardiac muscle; other tissues are down-regulated postnatal but re-expressed in tumours that express the gene during embryogenesis
Function putative tumour suppressor; proposed regulatory function for IGF2 expression (under debate)
Germinal hypermethylated in 10-20% of sporadic BWS cases; familial transmission unclear yet; loss of imprinting (LOI) can be induced in deletion mouse models
Somatic hypermethylated in 10-20% of sporadic BWS cases mostly somatic events due to UPD in mosaic form; LOI in tumours

Gene NameIGF2
Alias IGF-II, somatomedin A, Hs.75963
Location 11p15.5
Transcription 1356 bp mRNA, paternally expressed, maternal imprint
Description 180 amino acids, 20,14 kDa (unprocessed)
Expression IGF2 has the highest levels of expression in tissues that are affected by prenatal overgrowth in BWS; the main source of expression is liver; expression depends on promoter usage; P1 is exclusively active in adult liver, whereas P3 and P4 exert their action in liver prenatal; P2 is only active in certain tumour cell lines
Localisation secreted
Function embryonal growth factor, mitogen
Homology belongs to the insulin/IGF/relaxin family
Germinal hypomethylated; LOI in sporadic BWS cases; familial transmission unclear yet; BWS phenotype can be induced in igf2 overexpressing mouse models
Somatic hypomethylated, LOI in sporadic BWS cases; mostly somatic events due to UPD in mosaic form; LOI in tumours

Gene NameCDKN1C
Alias KIP2, P57KIP2, P57, CDKN5
Location 11p15.5
Description 1511 bp messenger, preferentially maternally expressed (paternal imprint)
Description 316 amino acids; 32,177 kDa, CDK inhibitory domain, PAPA repeat, conserved C-terminal domain
Expression It is expressed in the heart, brain, lung, skeletal muscle, kidney, pancreas and testis; high levels are seen in the placenta, low levels in liver
Localisation nuclear
Function Summary: Cyclin-dependent kinase inhibitor 1C is a tight-binding inhibitor of several G1 cyclin/Cdk complexes and a negative regulator of cell proliferation; mutations of CDKN1C are implicated in sporadic cancers and Beckwith-Wiedemann syndrome suggesting that it is a tumour suppressor candidate; in BWS however, no evidence for tumour association was found
Homology p21CIP1 CdK inhibitor gene family
Germinal mostly maternal, nucleotide substitutions, small deletions
Somatic CDKN1C mutations are described in tumour formation; mouse mutation-models reveal part of the BWS phenotype in particular the abdominal-wall defects

Gene NameKCNQ1OT1
Alias KCNQ1 overlapping transcript 1, LIT1, KvDMR1, KvLQT1-AS, Long QT intronic transcript 1
Location 11p15.5
Description maternally imprinted gene, > 80 kb RNA
Transcription intronic transcript 1, embedded in intron 9 (and 10) of KCNQ1, in opposite orientation; expressed in most human tissues and from the paternal allele, the maternal allele being imprinted through a specific methylation of a CpG island; abnormally expressed in patients with Beckwith-Wiedemann syndrome, independently of IGF2 imprinting; no abnormal imprinting in Wilms tumour
Expression untranslated
Function unknown; it is postulated that KCNQ1OT1 might influence the expression of nearby imprinted genes such as CDKN1C or IGF2/H19
Germinal aberrant methylation in 50-80% of BWS patients not always 100% (might be due to UPD in some cases); inheritance unclear
Somatic unclear; there is no association between aberrant methylation and tumour development

Gene NameZNF215
Alias zinc finger protein 215, BAZ2
Location 11p15.4
Description mRNA of 3480 bp, 9 exons, at least 5 splice variants; exon 9 runs antisense of a second gene: ZNF214
Transcription imprinted in a tissue specific manner, the maternal allele being preferentially expressed
Description 517 amino acids, 60,048 kDa; KRABA domain; similarities to a KRABB domain; SCAN box; nuclear localisation signal KKKR; 2 x 2 zinc-fingers
Expression widely expressed at low levels; expression is highest in testis; splice variants of ZNF215 show tissue specific expression
Localisation nuclear
Function putative transcription factor; ZNF215 was cloned from a region associated with hemihypertrophy, cardiac abnormalities, Wilms tumour and minor BWS features; as such the gene might be responsible for a distinct phenotype in BWS
Homology belongs to the Krueppel family of C2H2-type zinc finger proteins
Germinal various amino acids substitutions found in BWS / hemihypertrophy patients; causal relationship with phenotype unclear
Somatic in tumours no mutations found so far


Disruption of a novel imprinted zinc-finger gene, ZNF215, in Beckwith-Wiedemann syndrome.
Alders M, Ryan A, Hodges M, Bliek J, Feinberg AP, Privitera O, Westerveld A, Little PF, Mannens M
American journal of human genetics. 2000 ; 66 (5) : 1473-1484.
PMID 10762538
Macroglossia, omphalocele, adrenal cytomegaly, gigantism, and hyperplastic visceromegaly.
Beckwith J
Birth Defects. 1969 ; 5 : 188-196.
Risk of cancer during the first four years of life in children from The Beckwith-Wiedemann Syndrome Registry.
DeBaun MR, Tucker MA
The Journal of pediatrics. 1998 ; 132 (3 Pt 1) : 398-400.
PMID 9544889
Clinical features and natural history of Beckwith-Wiedemann syndrome: presentation of 74 new cases.
Elliott M, Bayly R, Cole T, Temple IK, Maher ER
Clinical genetics. 1994 ; 46 (2) : 168-174.
PMID 7820926
Multiple genetic loci within 11p15 defined by Beckwith-Wiedemann syndrome rearrangement breakpoints and subchromosomal transferable fragments.
Hoovers JM, Kalikin LM, Johnson LA, Alders M, Redeker B, Law DJ, Bliek J, Steenman M, Benedict M, Wiegant J, Lengauer C, Taillon-Miller P, Schlessinger D, Edwards MC, Elledge SJ, Ivens A, Westerveld A, Little P, Mannens M, Feinberg AP
Proceedings of the National Academy of Sciences of the United States of America. 1995 ; 92 (26) : 12456-12460.
PMID 8618920
Loss of imprinting of a paternally expressed transcript, with antisense orientation to KVLQT1, occurs frequently in Beckwith-Wiedemann syndrome and is independent of insulin-like growth factor II imprinting.
Lee MP, DeBaun MR, Mitsuya K, Galonek HL, Brandenburg S, Oshimura M, Feinberg AP
Proceedings of the National Academy of Sciences of the United States of America. 1999 ; 96 (9) : 5203-5208.
PMID 10220444
Molecular genetics of Wiedemann-Beckwith syndrome.
Li M, Squire JA, Weksberg R
American journal of medical genetics. 1998 ; 79 (4) : 253-259.
PMID 9781904
The Beckwith-Wiedemann syndrome phenotype and the risk of cancer.
Schneid H, Vazquez MP, Vacher C, Gourmelen M, Cabrol S, Le Bouc Y
Medical and pediatric oncology. 1997 ; 28 (6) : 411-415.
PMID 9143384
Genetics of Beckwith-Wiedemann syndrome-associated tumors: common genetic pathways.
Steenman M, Westerveld A, Mannens M
Genes, chromosomes & cancer. 2000 ; 28 (1) : 1-13.
PMID 10738297
Journal de genetique humaine. 1964 ; 13 : 223-232.
PMID 14231762


This paper should be referenced as such :
Mannens, M
Beckwith-Wiedemann syndrome
Atlas Genet Cytogenet Oncol Haematol. 2001;5(1):62-65.
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