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Ibrahim I, Scriver T, Basalom SA. No, it is not mutually exclusive! A case report of a girl with two genetic diagnoses: Craniofrontonasal dysplasia and pontocerebellar hypoplasia type 1B. Clin Case Rep 2023; 11:e7332. [PMID: 37180334 PMCID: PMC10172455 DOI: 10.1002/ccr3.7332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/15/2023] [Accepted: 04/23/2023] [Indexed: 05/16/2023] Open
Abstract
Key Clinical Message Multiple genetic disorders can coexist in one patient. When the phenotype is not fully explained with one diagnosis, it is recommended to perform further genetic investigations in search for coexisting second diagnosis. Abstract Craniofrontonasal dysplasia (CFND) (MIM: 304110) is an X-linked dominant disorder that shows paradoxically greater severity in heterozygous females than in hemizygous males. It is caused by a pathogenic variant in EFNB1. Pontocerebellar hypoplasia type 1B (PCH1B) (MIM: 614678) is an extremely rare condition with over 100 individuals reported to date. It is caused by biallelic pathogenic variants in EXOSC3. This report presents the case of a girl who was diagnosed prenatally with CFND based on the findings on the prenatal imaging and the known diagnosis of CFND in her mother. She has severe global development delay that cannot be explained solely by the CFND diagnosis. Around the age of 2 years, she was diagnosed with PCH1B following whole exome sequencing (WES) testing. The objective of this study is to highlight the importance of pursuing genetic investigation if the available genetic diagnosis cannot fully explain the clinical picture. This is a case report of one patient and review of the literature. Informed consent was obtained from the parents. WES was performed by a private lab using next-generation sequencing (NGS), DNA was sequenced on the NovaSeq 6000 using 2 × 150 bp paired-end read. WES identified the following: homozygous pathogenic variant in EXOSC3: C.395A>C, p.ASp132Ala, maternally inherited, likely pathogenic duplication at Xq13.1 (includes EFNB1) and paternally inherited 16p11.2 duplication that is classified as a variant of uncertain significance. Perusing more extensive genetic testing like: WES is indicated if the current genetic diagnosis cannot fully explain the phenotype in a patient.
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Affiliation(s)
- Iman Ibrahim
- School of Health Studies, Elborn CollegeWestern UniversityLondonOntarioCanada
| | - Tara Scriver
- Division of Medical Genetics, Department of Pediatrics, Royal University HospitalUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Shuaa A. Basalom
- Division of Medical Genetics, Department of Pediatrics, Royal University HospitalUniversity of SaskatchewanSaskatoonSaskatchewanCanada
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2
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Langeh N, Saluja S, Ethayathulla AS, Jana M, Shukla R, Palanichamy JK, Gupta N. Mosaic variegated aneuploidy syndrome 2 with biallelic novel CEP57 splice site variation in Indian siblings: Expanding the clinical and molecular spectrum. Clin Genet 2023; 103:478-483. [PMID: 36635612 DOI: 10.1111/cge.14297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/25/2022] [Accepted: 01/04/2023] [Indexed: 01/14/2023]
Abstract
Mosaic variegated aneuploidy syndrome 2 (MVA2) (MIM# 614114) is a rare autosomal recessive condition caused by biallelic loss of function variants in the CEP57 gene. MVA2 is characterized by a variable phenotype ranging from poor growth to facial dysmorphism, short stature and congenital heart defects. Only 11 families and 5 pathogenic variants of MVA2 have been described so far. Intragenic duplication of 11 nucleotides (c.915_925dup11) in homozygous or compound heterozygous state is the commonest genetic aberration (10/13). We describe the first Indian family with two siblings with a novel homozygous splice site variant (c.382+2T>C) in CEP57. Molecular characterization demonstrated skipping of exon 3 due to the variant with protein modeling predicting subsequent complete loss of function. This is the first report of a splice site variation in CEP57 leading to MVA2.
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Affiliation(s)
- Nitika Langeh
- Department of Pediatrics, Division of Genetics, AIIMS, New Delhi, India
| | | | | | - Manisha Jana
- Department of Radiodiagnosis, AIIMS, New Delhi, India
| | - Rashmi Shukla
- Department of Pediatrics, Division of Genetics, AIIMS, New Delhi, India
| | | | - Neerja Gupta
- Department of Pediatrics, Division of Genetics, AIIMS, New Delhi, India
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3
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Giacomozzi C, Martin A, Fernández MC, Gutiérrez M, Iascone M, Domené HM, Dominici FP, Bergadá I, Cangiano B, Persani L, Pennisi PA. Novel Insulin-Like Growth Factor 1 Gene Mutation: Broadening of the Phenotype and Implications for Insulin Resistance. J Clin Endocrinol Metab 2022; 108:1355-1369. [PMID: 36546343 DOI: 10.1210/clinem/dgac738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 11/23/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Insulin-like Growth Factor (IGF)1 gene mutations are extremely rare causes of pre- and post-natal growth retardation. Phenotype can be heterogenous with varying degrees of neurosensory deafness, cognitive defects, glucose metabolism impairment and short stature. This study describes a 12.6-year-old girl presenting severe short stature and insulin resistance, but with normal hearing and neurological development at the lower limit of normal. METHODS DNA was obtained from the proband and both parents for whole exome sequencing (WES). In silico analysis was performed to predict the impact of the IGF1 variant on IGF1 and insulin receptors (IGF1R and IR) signalling. Phosphorylation of the IGF1R at activating Tyr residues and cell proliferation analyses were used to assess the ability of each subject's IGF1 to bind and activate IGF1R. RESULTS The proband had low immunoreactive IGF1 in serum and WES revealed a novel homozygous IGF1 missense variant (c.247A > T), causing a change of serine 83 for cysteine (p.Ser83Cys; p.Ser35Cys in mature peptide). The proband's parents were heterozygous for this mutation. In silico analyses indicated the pathogenic potential of the variant with electrostatic variations with the potential of hampering the interaction with the IGF1R but strengthening the binding to IR. The mutant IGF1 protein had a significantly reduced activity on in vitro bioassays. MAIN CONCLUSIONS We describe a novel IGF1 mutation leading to severe loss of circulating IGF1 immunoreactivity and bioactivity, In silico modelling predicts that the mutant IGF1 could interfere with IR signalling, providing a possible explanation for the severe insulin resistance observed in the patient. The absence of significant hearing and neurodevelopmental involvement in the present case is unusual and broadens the clinical spectrum of IGF1 mutations.
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Affiliation(s)
- Claudio Giacomozzi
- Unit of Pediatrics, Department of Maternal and Child Health, Carlo Poma Hospital, ASST-Mantova, Mantua, Italy
| | - Ayelen Martin
- Centro de Investigaciones Endocrinológicas 'Dr César Bergadá' (CEDIE) CONICET - FEI - División de Endocrinología, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - María Celia Fernández
- Centro de Investigaciones Endocrinológicas 'Dr César Bergadá' (CEDIE) CONICET - FEI - División de Endocrinología, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Mariana Gutiérrez
- Centro de Investigaciones Endocrinológicas 'Dr César Bergadá' (CEDIE) CONICET - FEI - División de Endocrinología, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Maria Iascone
- Department of Medical Genetics, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Horacio M Domené
- Centro de Investigaciones Endocrinológicas 'Dr César Bergadá' (CEDIE) CONICET - FEI - División de Endocrinología, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Fernando P Dominici
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Química Biológica (IQUIFIB-CONICET), Buenos Aires, Argentina
| | - Ignacio Bergadá
- Centro de Investigaciones Endocrinológicas 'Dr César Bergadá' (CEDIE) CONICET - FEI - División de Endocrinología, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Biagio Cangiano
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20100 Milan, Italy
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, 20100 Milan, Italy
| | - Luca Persani
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20100 Milan, Italy
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, 20100 Milan, Italy
| | - Patricia A Pennisi
- Centro de Investigaciones Endocrinológicas 'Dr César Bergadá' (CEDIE) CONICET - FEI - División de Endocrinología, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
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Dual Molecular Diagnoses of Recessive Disorders in a Child from Consanguineous Parents: Case Report and Literature Review. Genes (Basel) 2022; 13:genes13122377. [PMID: 36553645 PMCID: PMC9778442 DOI: 10.3390/genes13122377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
The widespread use of whole exome sequencing (WES) resulted in the discovery of multilocus pathogenic variations (MPV), defined as two or more distinct or overlapping Mendelian disorders occurring in a patient, leading to a blended phenotype. In this study, we report on a child with autosomal recessive primary microcephaly-5 (MCPH5) and nephropathic cystinosis. The proband is the first child of consanguineous parents, presenting a complex phenotype including neurodevelopmental delay, microcephaly, growth restriction, significant delay of bone maturation, lissencephaly, and abnormality of neuronal migration, photophobia, and renal tubular acidosis. WES revealed two pathogenic and homozygous variants: a c.4174C>T variant in the ASPM gene and a c.382C>T variant in the CTNS gene, explaining the complex phenotype. The literature review showed that most of the patients harboring two variants in recessive disease genes are born to consanguineous parents. To the best of our knowledge, the patient herein described is the first one harboring pathogenic variants in both the ASPM and CTNS genes. These findings highlight the importance of searching for MPV in patients with complex phenotypes investigated by genome-wide testing methods, especially for those patients born to consanguineous parents.
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Rosina E, Pezzani L, Pezzoli L, Marchetti D, Bellini M, Pilotta A, Calabrese O, Nicastro E, Cirillo F, Cereda A, Scatigno A, Milani D, Iascone M. Atypical, Composite, or Blended Phenotypes: How Different Molecular Mechanisms Could Associate in Double-Diagnosed Patients. Genes (Basel) 2022; 13:genes13071275. [PMID: 35886058 PMCID: PMC9319862 DOI: 10.3390/genes13071275] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/13/2022] [Accepted: 07/13/2022] [Indexed: 12/10/2022] Open
Abstract
In the last few years, trio-Whole Exome Sequencing (WES) analysis has revolutionized the diagnostic process for patients with rare genetic syndromes, demonstrating its potential even in non-specific clinical pictures and in atypical presentations of known diseases. Multiple disorders in a single patient have been estimated to occur in approximately 2–7.5% of diagnosed cases, with higher frequency in consanguineous families. Here, we report the clinical and molecular characterisation of eight illustrative patients for whom trio-WES allowed for identifing more than one genetic condition. Double homozygosity represented the causal mechanism in only half of them, whereas the other half showed peculiar multilocus combinations. The paper takes into consideration difficulties and learned lessons from our experience and therefore supports the powerful role of wide analyses for ascertaining multiple genetic diseases in complex patients, especially when a clinical suspicion could account for the majority of clinical signs. It finally makes clear how a patient’s “deep phenotyping” might not be sufficient to suggest the presence of multiple genetic diagnoses but remains essential to validate an unexpected multilocus result from genetic tests.
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Affiliation(s)
- Erica Rosina
- Laboratory of Medical Genetics, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (E.R.); (L.P.); (D.M.); (M.B.); (M.I.)
| | - Lidia Pezzani
- Paediatric Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (L.P.); (E.N.); (A.C.); (A.S.)
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Laura Pezzoli
- Laboratory of Medical Genetics, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (E.R.); (L.P.); (D.M.); (M.B.); (M.I.)
| | - Daniela Marchetti
- Laboratory of Medical Genetics, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (E.R.); (L.P.); (D.M.); (M.B.); (M.I.)
| | - Matteo Bellini
- Laboratory of Medical Genetics, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (E.R.); (L.P.); (D.M.); (M.B.); (M.I.)
| | - Alba Pilotta
- Auxo-Endocrinology, Diabetology and Medical Genetic Unit, Department of Paediatrics, ASST Spedali Civili, 25123 Brescia, Italy;
| | - Olga Calabrese
- Medical Genetics Unit, Azienda Ospedaliera Universitaria di Modena, 41125 Modena, Italy;
| | - Emanuele Nicastro
- Paediatric Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (L.P.); (E.N.); (A.C.); (A.S.)
| | - Francesco Cirillo
- Pediatric Hepatology and Paediatric Liver Transplantation, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, 90127 Palermo, Italy;
| | - Anna Cereda
- Paediatric Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (L.P.); (E.N.); (A.C.); (A.S.)
| | - Agnese Scatigno
- Paediatric Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (L.P.); (E.N.); (A.C.); (A.S.)
| | - Donatella Milani
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
- Correspondence: ; Tel.: +39-02-55032560
| | - Maria Iascone
- Laboratory of Medical Genetics, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (E.R.); (L.P.); (D.M.); (M.B.); (M.I.)
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6
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Santos-Simarro F, Pacio M, Cueto-González AM, Mansilla E, Valenzuela-Palafoll MI, López-Grondona F, Lledín MD, Schuffelmann C, Del Pozo Á, Solis M, Vallcorba P, Lapunzina P, Menéndez Suso JJ, Siccha SM, Montejo JM, Mena R, Jiménez-Rodríguez C, García-Miñaúr S, Palomares-Bralo M. Mosaic Variegated Aneuploidy syndrome 2 caused by biallelic variants in CEP57, two new cases and review of the phenotype. Eur J Med Genet 2021; 64:104338. [PMID: 34500087 DOI: 10.1016/j.ejmg.2021.104338] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 09/01/2021] [Accepted: 09/04/2021] [Indexed: 11/20/2022]
Abstract
Mosaic Variegated Aneuploidy Syndrome 2 (MVA2; MIM 614114) is a rare autosomal recessive disorder, characterized by mosaic aneuploidies involving multiple chromosomes and tissues, caused by biallelic pathogenic variants in the CEP57 gene. Only 10 patients have been reported to date. We report two additional non related cases born to Moroccan consanguineous parents, carrying the previously described c.915_925dup11 CEP57 homozygous variant. Common features of these 12 cases include growth retardation, typically of prenatal onset, distinctive facial features, endocrine, cardiovascular and skeletal, abnormalities while malignancies have not been reported. This report describes the phenotypical spectrum of MVA2.
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Affiliation(s)
- Fernando Santos-Simarro
- Instituto de Genética Medica y Molecular (INGEMM), Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, U753), ISCIII, Madrid, Spain; European Reference Network, ERN ITHACA, Spain.
| | - Marta Pacio
- Instituto de Genética Medica y Molecular (INGEMM), Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, U753), ISCIII, Madrid, Spain; European Reference Network, ERN ITHACA, Spain.
| | - Anna María Cueto-González
- Departamento de Genética Clinical y Molecular,Grupo de Genética Médica, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Institut de Recerca (VHIR), Hospital Universitari, Vall d'Hebron, Barcelona, Spain; European Reference Network, ERN ITHACA, Spain; European Reference Network, ERN CRANIO, Spain.
| | - Elena Mansilla
- Instituto de Genética Medica y Molecular (INGEMM), Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, U753), ISCIII, Madrid, Spain; European Reference Network, ERN ITHACA, Spain.
| | - María Irene Valenzuela-Palafoll
- Departamento de Genética Clinical y Molecular,Grupo de Genética Médica, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Institut de Recerca (VHIR), Hospital Universitari, Vall d'Hebron, Barcelona, Spain; European Reference Network, ERN ITHACA, Spain.
| | - Fermina López-Grondona
- Departamento de Genética Clinical y Molecular,Grupo de Genética Médica, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Institut de Recerca (VHIR), Hospital Universitari, Vall d'Hebron, Barcelona, Spain.
| | - María Dolores Lledín
- Servicio de Hepatología Pediátrica, Hospital Universitario La Paz, Madrid, Spain.
| | - Cristina Schuffelmann
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario La Paz, Madrid, Spain.
| | - Ángela Del Pozo
- Instituto de Genética Medica y Molecular (INGEMM), Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, U753), ISCIII, Madrid, Spain.
| | - Mario Solis
- Instituto de Genética Medica y Molecular (INGEMM), Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, U753), ISCIII, Madrid, Spain.
| | - Patricia Vallcorba
- Instituto de Genética Medica y Molecular (INGEMM), Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, U753), ISCIII, Madrid, Spain; European Reference Network, ERN ITHACA, Spain.
| | - Pablo Lapunzina
- Instituto de Genética Medica y Molecular (INGEMM), Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, U753), ISCIII, Madrid, Spain; European Reference Network, ERN ITHACA, Spain.
| | | | - Sofia M Siccha
- Instituto de Genética Medica y Molecular (INGEMM), Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
| | - Juan Manuel Montejo
- Instituto de Genética Medica y Molecular (INGEMM), Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, U753), ISCIII, Madrid, Spain.
| | - Rocío Mena
- Instituto de Genética Medica y Molecular (INGEMM), Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, U753), ISCIII, Madrid, Spain.
| | - Carmen Jiménez-Rodríguez
- Instituto de Genética Medica y Molecular (INGEMM), Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
| | - Sixto García-Miñaúr
- Instituto de Genética Medica y Molecular (INGEMM), Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, U753), ISCIII, Madrid, Spain; European Reference Network, ERN ITHACA, Spain.
| | - María Palomares-Bralo
- Instituto de Genética Medica y Molecular (INGEMM), Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, U753), ISCIII, Madrid, Spain; European Reference Network, ERN ITHACA, Spain.
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7
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Pezzani L, Pezzoli L, Pansa A, Facchinetti B, Marchetti D, Scatigno A, Lincesso AR, Perego L, Pingue M, Pellicioli I, Migliazza L, Mangili G, Galletti L, Giussani U, Bonanomi E, Cereda A, Iascone M. Double homozygosity in CEP57 and DYNC2H1 genes detected by WES: Composite or expanded phenotype? Mol Genet Genomic Med 2020; 8:e1064. [PMID: 31943948 PMCID: PMC7057129 DOI: 10.1002/mgg3.1064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/02/2019] [Accepted: 11/06/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In the last few years trio-whole exome sequencing (WES) analysis has demonstrated its potential in obtaining genetic diagnoses even in nonspecific clinical pictures and in atypical presentations of known diseases. Moreover WES allows the detection of variants in multiple genes causing different genetic conditions in a single patient, in about 5% of cases. The resulting phenotype may be clinically discerned as variability in the expression of a known phenotype, or as a new unreported syndromic condition. METHODS Trio-WES was performed on a 4-month-old baby with a complex clinical presentation characterized by skeletal anomalies, congenital heart malformation, congenital hypothyroidism, generalized venous and arterial hypoplasia, and recurrent infections. RESULTS WES detected two different homozygous variants, one in CEP57, the gene responsible for mosaic variegated aneuploidy syndrome 2, the other in DYNC2H1, the main gene associated with short-rib thoracic dysplasia. CONCLUSION The contribution of these two different genetic causes in determining the phenotype of our patient is discussed, including some clinical signs not explained by the detected variants. The report then highlights the role of WES in providing complete and fast diagnosis in patients with complex presentations of rare genetic syndromes, with important implications in the assessment of recurrence risk.
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Affiliation(s)
- Lidia Pezzani
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Laura Pezzoli
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Alessandra Pansa
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Daniela Marchetti
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Anna R Lincesso
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Loredana Perego
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Monica Pingue
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Lucia Migliazza
- Chirurgia Pediatrica, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Ursula Giussani
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Ezio Bonanomi
- Terapia Intensiva Pediatrica, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Anna Cereda
- Pediatria, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Maria Iascone
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, Bergamo, Italy
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