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Angelozzi M, Karvande A, Molin AN, Ritter AL, Leonard JMM, Savatt JM, Douglass K, Myers SM, Grippa M, Tolchin D, Zackai E, Donoghue S, Hurst ACE, Descartes M, Smith K, Velasco D, Schmanski A, Crunk A, Tokita MJ, de Lange IM, van Gassen K, Robinson H, Guegan K, Suri M, Patel C, Bournez M, Faivre L, Tran-Mau-Them F, Baker J, Fabie N, Weaver K, Shillington A, Hopkin RJ, Barge-Schaapveld DQCM, Ruivenkamp CA, Bökenkamp R, Vergano S, Seco Moro MN, Díaz de Bustamante A, Misra VK, Kennelly K, Rogers C, Friedman J, Wigby KM, Lenberg J, Graziano C, Ahrens-Nicklas RC, Lefebvre V. Consolidation of the clinical and genetic definition of a SOX4-related neurodevelopmental syndrome. J Med Genet 2022; 59:1058-1068. [PMID: 35232796 DOI: 10.1136/jmedgenet-2021-108375] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/13/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND A neurodevelopmental syndrome was recently reported in four patients with SOX4 heterozygous missense variants in the high-mobility-group (HMG) DNA-binding domain. The present study aimed to consolidate clinical and genetic knowledge of this syndrome. METHODS We newly identified 17 patients with SOX4 variants, predicted variant pathogenicity using in silico tests and in vitro functional assays and analysed the patients' phenotypes. RESULTS All variants were novel, distinct and heterozygous. Seven HMG-domain missense and five stop-gain variants were classified as pathogenic or likely pathogenic variant (L/PV) as they precluded SOX4 transcriptional activity in vitro. Five HMG-domain and non-HMG-domain missense variants were classified as of uncertain significance (VUS) due to negative results from functional tests. When known, inheritance was de novo or from a mosaic unaffected or non-mosaic affected parent for patients with L/PV, and from a non-mosaic asymptomatic or affected parent for patients with VUS. All patients had neurodevelopmental, neurological and dysmorphic features, and at least one cardiovascular, ophthalmological, musculoskeletal or other somatic anomaly. Patients with L/PV were overall more affected than patients with VUS. They resembled patients with other neurodevelopmental diseases, including the SOX11-related and Coffin-Siris (CSS) syndromes, but lacked the most specific features of CSS. CONCLUSION These findings consolidate evidence of a fairly non-specific neurodevelopmental syndrome due to SOX4 haploinsufficiency in neurogenesis and multiple other developmental processes.
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Affiliation(s)
- Marco Angelozzi
- Surgery/Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania, USA
| | - Anirudha Karvande
- Surgery/Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania, USA
| | - Arnaud N Molin
- Surgery/Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania, USA
| | - Alyssa L Ritter
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jacqueline M M Leonard
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Juliann M Savatt
- Autism & Developmental Medicine Institute, Geisinger, Danville, Pennsylvania, USA
| | - Kristen Douglass
- Autism & Developmental Medicine Institute, Geisinger, Danville, Pennsylvania, USA
| | - Scott M Myers
- Autism & Developmental Medicine Institute, Geisinger, Danville, Pennsylvania, USA
| | - Mina Grippa
- U.O. Genetica Medica, Universita di Bologna, Bologna, Italy
| | - Dara Tolchin
- Surgery/Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania, USA
| | - Elaine Zackai
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sarah Donoghue
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Anna C E Hurst
- Department of Genetics, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Maria Descartes
- Department of Genetics, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Kirstin Smith
- Department of Genetics, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Danita Velasco
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Andrew Schmanski
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Amy Crunk
- GeneDx Inc, Gaithersburg, Maryland, USA
| | | | - Iris M de Lange
- Department of Medical Genetics, University Medical Centre Utrecht Brain Centre, Utrecht, The Netherlands
| | - Koen van Gassen
- Department of Medical Genetics, University Medical Centre Utrecht Brain Centre, Utrecht, The Netherlands
| | - Hannah Robinson
- Exeter Genomics Laboratory, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Katie Guegan
- Exeter Genomics Laboratory, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Mohnish Suri
- Clinical Genetics, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Chirag Patel
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Marie Bournez
- Centres de référence Anomalies du Développement et Syndrome Malformatifs, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Laurence Faivre
- Centre de Génétique, Centre Hospitalier Universitaire de Dijon Hôpital d'Enfants, Dijon, France
| | - Frédéric Tran-Mau-Them
- Genetics of Developmental Disorders, INSERM - Bourgogne Franche-Comté University, UMR 1231 GAD Team, Dijon, France.,Functional Unit 6254 Innovation in Genomic Diagnosis of Rare Diseases, CHU Dijon Bourgogne, Dijon, France
| | - Janice Baker
- Genomics and Genetic Medicine, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Noelle Fabie
- Genomics and Genetic Medicine, Children's Minnesota, Minneapolis, Minnesota, USA
| | - K Weaver
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Amelle Shillington
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Robert J Hopkin
- Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Claudia Al Ruivenkamp
- Laboratory for Diagnostic Genome Analyses, Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Regina Bökenkamp
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Samantha Vergano
- Division of Medical Genetics and Metabolism, Children's Hospital of The King's Daughters, Norfolk, Virginia, USA
| | | | | | - Vinod K Misra
- Department of Pediatrics, Division of Genetic, Genomic, and Metabolic Disorders, Children's Hospital of Michigan, Detroit, Michigan, USA.,Discipline of Pediatrics, Central Michigan University, Mount Pleasant, Michigan, USA
| | - Kelly Kennelly
- Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan, USA
| | - Caleb Rogers
- Department of Molecular and Medical Genetics, Oregon Health & Science University School of Medicine, Portland, Oregon, USA
| | - Jennifer Friedman
- Department of Pediatrics, University of California San Diego, San Diego, California, USA.,Division of Genetics/Dysmorphology and Institute for Genomic Medicine, Rady Children's Hospital, San Diego, California, USA.,Department of Neurosciences, University of California San Diego, San Diego, California, USA.,Division of Neurology, Rady Children's Hospital, San Diego, California, USA
| | - Kristen M Wigby
- Department of Pediatrics, University of California San Diego, San Diego, California, USA.,Division of Genetics/Dysmorphology and Institute for Genomic Medicine, Rady Children's Hospital, San Diego, California, USA
| | - Jerica Lenberg
- Division of Genetics/Dysmorphology and Institute for Genomic Medicine, Rady Children's Hospital, San Diego, California, USA
| | - Claudio Graziano
- Department of Pediatrics, University of California San Diego, San Diego, California, USA .,Division of Genetics/Dysmorphology and Institute for Genomic Medicine, Rady Children's Hospital, San Diego, California, USA.,Department of Neurosciences, University of California San Diego, San Diego, California, USA.,Division of Neurology, Rady Children's Hospital, San Diego, California, USA.,U.O. Genetica Medica, AUSL della Romagna Rimini, Cesena, Italy
| | - Rebecca C Ahrens-Nicklas
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Veronique Lefebvre
- Surgery/Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania, USA
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