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Pollak RM, Tilmon JC, Murphy MM, Gambello MJ, Sanchez Russo R, Dormans JP, Mulle JG. Musculoskeletal phenotypes in 3q29 deletion syndrome. Am J Med Genet A 2023; 191:2749-2756. [PMID: 37691301 PMCID: PMC10662927 DOI: 10.1002/ajmg.a.63384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/20/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023]
Abstract
3q29 deletion syndrome (3q29del) is a rare genomic disorder caused by a 1.6 Mb deletion (hg19, chr3:195725000-197350000). 3q29del is associated with neurodevelopmental and psychiatric phenotypes, including an astonishing >40-fold increased risk for schizophrenia, but medical phenotypes are less well-described. We used the online 3q29 registry of 206 individuals (3q29deletion.org) to recruit 57 individuals with 3q29del (56.14% male) and requested information about musculoskeletal phenotypes with a custom questionnaire. 85.96% of participants with 3q29del reported at least one musculoskeletal phenotype. Congenital anomalies were most common (70.18%), with pes planus (40.35%), pectus excavatum (22.81%), and pectus carinatum (5.26%) significantly elevated relative to the pediatric general population. 49.12% of participants reported fatigue after 30 min or less of activity. Bone fractures (8.77%) were significantly elevated relative to the pediatric general population. Participants commonly report receiving medical care for musculoskeletal complaints (71.93%), indicating that these phenotypes impact quality of life for individuals with 3q29del. This is the most comprehensive description of musculoskeletal phenotypes in 3q29del to date, suggests ideas for clinical evaluation, and expands our understanding of the phenotypic spectrum of this syndrome.
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Affiliation(s)
- Rebecca M Pollak
- Center for Advanced Biotechnology and Medicine, Robert Wood Johnson Medical School, Rutgers University, Piscataway, New Jersey, USA
| | - Jacob C Tilmon
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Melissa M Murphy
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael J Gambello
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rossana Sanchez Russo
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - John P Dormans
- Emeritus Professor of Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jennifer G Mulle
- Center for Advanced Biotechnology and Medicine, Robert Wood Johnson Medical School, Rutgers University, Piscataway, New Jersey, USA
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, New Jersey, USA
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2
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Pollak RM, Tilmon JC, Murphy MM, Gambello MJ, Russo RS, Dormans JP, Mulle JG. Musculoskeletal phenotypes in 3q29 deletion syndrome. medRxiv 2023:2023.04.03.23288084. [PMID: 37066183 PMCID: PMC10104205 DOI: 10.1101/2023.04.03.23288084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
3q29 deletion syndrome (3q29del) is a rare genomic disorder caused by a 1.6 Mb deletion (hg19, chr3:195725000â€"197350000). 3q29del is associated with neurodevelopmental and psychiatric phenotypes, including an astonishing >40-fold increased risk for schizophrenia, but medical phenotypes are less well-described. We used the online 3q29 registry ( 3q29deletion.org ) to recruit 57 individuals with 3q29del (56.14% male) and requested information about musculoskeletal phenotypes with a custom questionnaire. 85.96% of participants with 3q29del reported at least one musculoskeletal phenotype. Congenital anomalies were most common (70.18%), with pes planus (40.35%), pectus excavatum (22.81%), and pectus carinatum (5.26%) significantly elevated relative to the pediatric general population. 49.12% of participants reported fatigue after 30 minutes or less of activity. Bone fractures (8.77%) were significantly elevated relative to the pediatric general population, suggesting 3q29del impacts bone strength. Participants commonly report receiving medical care for musculoskeletal complaints (71.93%), indicating that these phenotypes impact quality of life for individuals with 3q29del. This is the most comprehensive description of musculoskeletal phenotypes in 3q29del to date, suggests ideas for clinical evaluation, and expands our understanding of the phenotypic spectrum of this syndrome.
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Affiliation(s)
- Rebecca M Pollak
- Center for Advanced Biotechnology and Medicine, Robert Wood Johnson Medical School, Rutgers University
| | | | | | | | | | - John P Dormans
- Emeritus Professor of Orthopedic Surgery, University of Pennsylvania
| | - Jennifer G Mulle
- Center for Advanced Biotechnology and Medicine, Robert Wood Johnson Medical School, Rutgers University
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University
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Biedziak B, Dąbrowska J, Szponar-Żurowska A, Bukowska-Olech E, Jamsheer A, Mojs E, Mulle J, Płoski R, Mostowska A. Identification of a new familial case of 3q29 deletion syndrome associated with cleft lip and palate via whole-exome sequencing. Am J Med Genet A 2023; 191:205-219. [PMID: 36317839 DOI: 10.1002/ajmg.a.63015] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 03/14/2022] [Revised: 08/22/2022] [Accepted: 09/24/2022] [Indexed: 11/06/2022]
Abstract
Many unbalanced large copy number variants reviewed in the paper are associated with syndromic orofacial clefts, including a 1.6 Mb deletion on chromosome 3q29. The current report presents a new family with this recurrent deletion identified via whole-exome sequencing and confirmed by array comparative genomic hybridization. The proband exhibited a more severe clinical phenotype than his affected mother, comprising right-sided cleft lip/alveolus and cleft palate, advanced dental caries, heart defect, hypospadias, psychomotor, and speech delay, and an intellectual disability. Data analysis from the 3q29 registry revealed that the 3q29 deletion increases the risk of clefting by nearly 30-fold. No additional rare and pathogenic nucleotide variants were identified that could explain the clefting phenotype and observed intrafamilial phenotypic heterogeneity. These data suggest that the 3q29 deletion may be the primary risk factor for clefting, with additional genomic variants located outside the coding sequences, methylation changes, or environmental exposure serving as modifiers of this risk. Additional studies, including whole-genome sequencing or methylation analyses, should be performed to identify genetic factors underlying the phenotypic variation associated with the recurrent 3q29 deletion.
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Affiliation(s)
- Barbara Biedziak
- Department of Orthodontics and Craniofacial Anomalies, Poznan University of Medical Sciences, Poznan, Poland
| | - Justyna Dąbrowska
- Department of Biochemistry and Molecular Biology, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Szponar-Żurowska
- Department of Orthodontics and Craniofacial Anomalies, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Aleksander Jamsheer
- Department of Medical Genetics, Poznan University of Medical Sciences, Poznan, Poland
| | - Ewa Mojs
- Department of Clinical Psychology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jennifer Mulle
- Psychiatry, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
| | - Rafał Płoski
- Department of Medical Genetics, Warsaw Medical University, Warsaw, Poland
| | - Adrianna Mostowska
- Department of Biochemistry and Molecular Biology, Poznan University of Medical Sciences, Poznan, Poland
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Pollak RM, Pincus JE, Burrell TL, Cubells JF, Klaiman C, Murphy MM, Saulnier CA, Walker EF, White SP, Mulle JG. Autism spectrum disorder symptom expression in individuals with 3q29 deletion syndrome. Mol Autism 2022; 13:50. [PMID: 36566217 PMCID: PMC9789637 DOI: 10.1186/s13229-022-00533-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/11/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The 1.6 Mb 3q29 deletion is associated with neurodevelopmental and neuropsychiatric phenotypes, including a 19-fold increased risk for autism spectrum disorder (ASD). Previous work by our team identified elevated social disability in this population via parent-report questionnaires. However, clinical features of ASD in this population have not been explored in detail. METHODS Thirty-one individuals with 3q29 deletion syndrome (3q29del, 61.3% male) were evaluated using two gold-standard clinical ASD evaluations: the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), and the Autism Diagnostic Interview, Revised (ADI-R). Four matched comparators for each subject were ascertained from the National Database for Autism Research. Item-level scores on the ADOS-2 and ADI-R were compared between subjects with 3q29del and matched comparators. RESULTS Subjects with 3q29del and no ASD (3q29del-ASD) had greater evidence of social disability compared to typically developing (TD) comparison subjects across the ADOS-2. Subjects with 3q29del and ASD (3q29del + ASD) were largely indistinguishable from non-syndromic ASD (nsASD) subjects on the ADOS-2. 3q29del + ASD performed significantly better on social communication on the ADI-R than nsASD (3q29 + ASD mean = 11.36; nsASD mean = 15.70; p = 0.01), and this was driven by reduced deficits in nonverbal communication (3q29 + ASD mean = 1.73; nsASD mean = 3.63; p = 0.03). 3q29del + ASD reported significantly later age at the first two-word phrase compared to nsASD (3q29del + ASD mean = 43.89 months; nsASD mean = 37.86 months; p = 0.01). However, speech delay was not related to improved nonverbal communication in 3q29del + ASD. LIMITATIONS There were not enough TD comparators with ADI-R data in NDAR to include in the present analysis. Additionally, our relatively small sample size made it difficult to assess race and ethnicity effects. CONCLUSIONS 3q29del is associated with significant social disability, irrespective of ASD diagnosis. 3q29del + ASD have similar levels of social disability to nsASD, while 3q29del-ASD have significantly increased social disability compared to TD individuals. However, social communication is reasonably well preserved in 3q29del + ASD relative to nsASD. It is critical that verbal ability and social disability be examined separately in this population to ensure equal access to ASD and social skills evaluations and services.
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Affiliation(s)
- Rebecca M. Pollak
- grid.430387.b0000 0004 1936 8796Center for Advanced Biotechnology and Medicine, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ USA
| | - Jordan E. Pincus
- grid.189967.80000 0001 0941 6502Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA USA ,grid.189967.80000 0001 0941 6502Marcus Autism Center, Children’s Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA USA ,grid.256304.60000 0004 1936 7400Clinical Psychology, College of Arts and Sciences, Georgia State University, Atlanta, GA USA
| | - T. Lindsey Burrell
- grid.189967.80000 0001 0941 6502Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA USA
| | - Joseph F. Cubells
- grid.189967.80000 0001 0941 6502Department of Human Genetics, School of Medicine, Emory University, Atlanta, GA USA ,grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioral Science, School of Medicine, Emory University, Atlanta, GA USA
| | - Cheryl Klaiman
- grid.189967.80000 0001 0941 6502Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA USA ,grid.189967.80000 0001 0941 6502Marcus Autism Center, Children’s Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA USA
| | - Melissa M. Murphy
- grid.189967.80000 0001 0941 6502Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA USA
| | - Celine A. Saulnier
- grid.189967.80000 0001 0941 6502Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA USA ,Neurodevelopmental Assessment and Consulting Services, Decatur, GA USA
| | - Elaine F. Walker
- grid.189967.80000 0001 0941 6502Department of Psychology, Emory University, Atlanta, GA USA
| | - Stormi Pulver White
- grid.189967.80000 0001 0941 6502Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA USA ,grid.189967.80000 0001 0941 6502Marcus Autism Center, Children’s Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA USA
| | - Jennifer G. Mulle
- grid.430387.b0000 0004 1936 8796Center for Advanced Biotechnology and Medicine, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ USA ,grid.430387.b0000 0004 1936 8796Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, 679 Hoes Lane West, NJ 08854 Piscataway, USA
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Glassford MR, Purcell RH, Pass S, Murphy MM, Bassell GJ, Mulle JG. Caregiver Perspectives on a Child's Diagnosis of 3q29 Deletion: "We Can't Just Wish This Thing Away". J Dev Behav Pediatr 2022; 43:e94-e102. [PMID: 34320535 PMCID: PMC8792091 DOI: 10.1097/dbp.0000000000000977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 02/15/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Genetic diagnoses are increasingly common in cases of intellectual disability and developmental delay. Although ascertainment of a relatively common, well-studied variant may provide guidance related to treatments and developmental expectations, it is less clear how the diagnosis of a rare variant affects caregivers, especially when the phenotype may include later-onset manifestations such as psychosis. In this study, we sought to identify caregiver concerns in the first qualitative study to assess the psychosocial impact of diagnosis on caregivers of individuals with 3q29 deletion syndrome (3q29Del), which is associated with a 40-fold increase in risk for psychosis. METHODS Participants were recruited from the national 3q29Del registry housed at Emory University (3q29deletion.org). Fifteen participants completed a semistructured phone interview during which they were asked about their experiences before, during, and after their child received a diagnosis of 3q29Del. Interview responses were analyzed using the general inductive approach, and overarching themes were identified. RESULTS We identified the following overarching themes: difficult "diagnostic odyssey," mixed feelings about diagnosis, frustration with degree of uncertainty, and importance of resources. Importantly, our data suggest that future risk for psychosis is often not disclosed by medical professionals, consistent with the experience of individuals with 22q11.2 deletion syndrome. CONCLUSIONS These results highlight potential gaps in how caregivers are informed of risk for adult-onset conditions and indicate key caregiver concerns for consideration in the diagnosis of 3q29Del.
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Affiliation(s)
- Megan R Glassford
- Department of Human Genetics, Emory University School of Medicine, Atlanta GA; Ms. Glassford is now with the Department of Pediatric Genetics, University of Michigan, Ann Arbor, MI; Ms. Pass is now with the Anderson Cancer Center, University of Texas, Houston, TX
| | - Ryan H Purcell
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA
| | - Sarah Pass
- Department of Human Genetics, Emory University School of Medicine, Atlanta GA; Ms. Glassford is now with the Department of Pediatric Genetics, University of Michigan, Ann Arbor, MI; Ms. Pass is now with the Anderson Cancer Center, University of Texas, Houston, TX
| | - Melissa M Murphy
- Department of Human Genetics, Emory University School of Medicine, Atlanta GA; Ms. Glassford is now with the Department of Pediatric Genetics, University of Michigan, Ann Arbor, MI; Ms. Pass is now with the Anderson Cancer Center, University of Texas, Houston, TX
| | - Gary J Bassell
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA
| | - Jennifer G Mulle
- Department of Human Genetics, Emory University School of Medicine, Atlanta GA; Ms. Glassford is now with the Department of Pediatric Genetics, University of Michigan, Ann Arbor, MI; Ms. Pass is now with the Anderson Cancer Center, University of Texas, Houston, TX
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta GA
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Cable J, Purcell RH, Robinson E, Vorstman JAS, Chung WK, Constantino JN, Sanders SJ, Sahin M, Dolmetsch RE, Shah B, Thurm A, Martin CL, Bearden CE, Mulle JG. Harnessing rare variants in neuropsychiatric and neurodevelopment disorders-a Keystone Symposia report. Ann N Y Acad Sci 2021; 1506:5-17. [PMID: 34342000 PMCID: PMC8688183 DOI: 10.1111/nyas.14658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 11/28/2022]
Abstract
Neurodevelopmental neuropsychiatric disorders, such as autism spectrum disorder and schizophrenia, have strong genetic risk components, but the underlying mechanisms have proven difficult to decipher. Rare, high-risk variants may offer an opportunity to delineate the biological mechanisms responsible more clearly for more common idiopathic diseases. Indeed, different rare variants can cause the same behavioral phenotype, demonstrating genetic heterogeneity, while the same rare variant can cause different behavioral phenotypes, demonstrating variable expressivity. These observations suggest convergent underlying biological and neurological mechanisms; identification of these mechanisms may ultimately reveal new therapeutic targets. At the 2021 Keystone eSymposium "Neuropsychiatric and Neurodevelopmental Disorders: Harnessing Rare Variants" a panel of experts in the field described significant progress in genomic discovery and human phenotyping and raised several consistent issues, including the need for detailed natural history studies of rare disorders, the challenges in cohort recruitment, and the importance of viewing phenotypes as quantitative traits that are impacted by rare variants.
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Affiliation(s)
| | - Ryan H. Purcell
- Department of Cell Biology, Emory University School of Medicine, Atlanta, Georgia
| | - Elise Robinson
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Jacob A. S. Vorstman
- Department of Psychiatry and The Centre for Applied Genomics, Program in Genetics and Genome Biology, Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Wendy K. Chung
- Departments of Pediatrics and Medicine, Columbia University, New York, New York
- Simons Foundation, New York, New York
| | - John N. Constantino
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Stephan J. Sanders
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA
| | - Mustafa Sahin
- Rosamund Stone Zander Translational Neuroscience Center, F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Bina Shah
- Project 8p Foundation, Commission on Novel Technologies for Neurodevelopmental CNVs, New York, New York
| | - Audrey Thurm
- Neurodevelopmental and Behavioral Phenotyping, NIMH, National Institutes of Health, Bethesda, Maryland
| | - Christa L. Martin
- Autism & Developmental Medicine Institute, Geisinger, Danville, Pennsylvania
| | - Carrie E. Bearden
- Integrative Center for Neurogenetics, Departments of Psychiatry and Biobehavioral Science and Psychology, University of California Los Angeles, Los Angeles, California
| | - Jennifer G. Mulle
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia
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Mosley TJ, Johnston HR, Cutler DJ, Zwick ME, Mulle JG. Sex-specific recombination patterns predict parent of origin for recurrent genomic disorders. BMC Med Genomics 2021; 14:154. [PMID: 34107974 PMCID: PMC8190997 DOI: 10.1186/s12920-021-00999-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 06/02/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Structural rearrangements of the genome, which generally occur during meiosis and result in large-scale (> 1 kb) copy number variants (CNV; deletions or duplications ≥ 1 kb), underlie genomic disorders. Recurrent pathogenic CNVs harbor similar breakpoints in multiple unrelated individuals and are primarily formed via non-allelic homologous recombination (NAHR). Several pathogenic NAHR-mediated recurrent CNV loci demonstrate biases for parental origin of de novo CNVs. However, the mechanism underlying these biases is not well understood. METHODS We performed a systematic, comprehensive literature search to curate parent of origin data for multiple pathogenic CNV loci. Using a regression framework, we assessed the relationship between parental CNV origin and the male to female recombination rate ratio. RESULTS We demonstrate significant association between sex-specific differences in meiotic recombination and parental origin biases at these loci (p = 1.07 × 10-14). CONCLUSIONS Our results suggest that parental origin of CNVs is largely influenced by sex-specific recombination rates and highlight the need to consider these differences when investigating mechanisms that cause structural variation.
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Affiliation(s)
- Trenell J Mosley
- Graduate Program in Genetics and Molecular Biology, Laney Graduate School, Emory University, 201 Dowman Drive, Atlanta, GA, 30322, USA
- Department of Human Genetics, Emory University School of Medicine, 615 Michael Street, Whitehead Building Suite 300, Atlanta, GA, 30322, USA
| | - H Richard Johnston
- Department of Human Genetics, Emory University School of Medicine, 615 Michael Street, Whitehead Building Suite 300, Atlanta, GA, 30322, USA
- Emory Integrated Computational Core, Emory University, 101 Woodruff Circle, Atlanta, GA, 30322, USA
| | - David J Cutler
- Department of Human Genetics, Emory University School of Medicine, 615 Michael Street, Whitehead Building Suite 300, Atlanta, GA, 30322, USA
| | - Michael E Zwick
- Department of Human Genetics, Emory University School of Medicine, 615 Michael Street, Whitehead Building Suite 300, Atlanta, GA, 30322, USA
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA, 30322, USA
| | - Jennifer G Mulle
- Department of Human Genetics, Emory University School of Medicine, 615 Michael Street, Whitehead Building Suite 300, Atlanta, GA, 30322, USA.
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA.
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Murphy MM, Burrell TL, Cubells JF, Epstein MT, Espana R, Gambello MJ, Goines K, Klaiman C, Koh S, Russo RS, Saulnier CA, Walker E, Mulle JG. Comprehensive phenotyping of neuropsychiatric traits in a multiplex 3q29 deletion family: a case report. BMC Psychiatry 2020; 20:184. [PMID: 32321479 PMCID: PMC7179007 DOI: 10.1186/s12888-020-02598-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND 3q29 deletion syndrome is associated with a range of medical, neurodevelopmental, and psychiatric phenotypes. The deletion is usually de novo but cases have been reported where the deletion is inherited from apparently unaffected parents. The presence of these unaffected or mildly affected individuals suggests there may be an ascertainment bias for severely affected cases of 3q29 deletion syndrome, thus the more deleterious consequence of the 3q29 deletion may be overestimated. However, a substantial fraction of 3q29 deletion syndrome morbidity is due to psychiatric illness. In many case reports, probands and transmitting parents are not systematically evaluated for psychiatric traits. Here we report results from a systematic phenotyping protocol for neurodevelopmental and neuropsychiatric traits applied to all 3q29 deletion carriers in a multiplex family. CASE PRESENTATION Through the 3q29 registry at Emory University, a multiplex family was identified where three offspring had a paternally inherited 3q29 deletion. We evaluated all 4 3q29 deletion family members using our previously described standardized, systematic phenotyping protocol. The transmitting parent reported no psychiatric history, however upon evaluation he was discovered to meet criteria for multiple psychiatric diagnoses including previously undiagnosed schizoaffective disorder. All four 3q29 deletion individuals in the pedigree had multiple psychiatric diagnoses that interfered with quality of life and prohibited successful academic and occupational functioning. Cognitive ability for all individuals was average or below average, but within the normal range. CONCLUSIONS This is the first case report of inherited 3q29 deletion syndrome where all affected individuals in the pedigree have been comprehensively and systematically evaluated for neurodevelopmental and psychiatric symptoms, using a standard battery of normed instruments administered by expert clinicians. Our investigation reveals that individuals with 3q29 deletion syndrome may have psychiatric morbidity that is debilitating, but only apparent through specialized evaluation by an expert. In the absence of appropriate evaluation, individuals with 3q29 deletion syndrome may suffer from psychiatric illness but lack avenues for access to care. The individuals evaluated here all have cognition in the normal range alongside multiple psychiatric diagnoses each, suggesting that cognitive ability alone is not a representative proxy for 3q29 deletion-associated disability. These results require replication in a larger cohort of individuals with 3q29 deletion syndrome.
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Affiliation(s)
- Melissa M Murphy
- Department of Human Genetics, Emory University School of Medicine, Whitehead 305M, 615 Michael Street, Atlanta, GA, 30322, USA
| | - T Lindsey Burrell
- Department of Pediatrics, Emory University School of Medicine, Atlanta, USA
- Marcus Autism Center, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, USA
| | - Joseph F Cubells
- Departments of Human Genetics and Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, USA
| | - Michael T Epstein
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, USA
| | - Roberto Espana
- Department of Psychology, Emory University, Atlanta, USA
| | - Michael J Gambello
- Department of Human Genetics, Emory University School of Medicine, Whitehead 305M, 615 Michael Street, Atlanta, GA, 30322, USA
| | - Katrina Goines
- Department of Psychology, Emory University, Atlanta, USA
| | - Cheryl Klaiman
- Department of Pediatrics, Emory University School of Medicine, Atlanta, USA
- Marcus Autism Center, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, USA
| | - Sookyong Koh
- Department of Pediatrics, Emory University School of Medicine, Atlanta, USA
| | - Rossana Sanchez Russo
- Department of Human Genetics, Emory University School of Medicine, Whitehead 305M, 615 Michael Street, Atlanta, GA, 30322, USA
| | - Celine A Saulnier
- Department of Pediatrics, Emory University School of Medicine, Atlanta, USA
- Neurodevelopmental Assessment & Consulting Services, Decatur, USA
| | - Elaine Walker
- Department of Psychology, Emory University, Atlanta, USA
| | - Jennifer Gladys Mulle
- Department of Human Genetics, Emory University School of Medicine, Whitehead 305M, 615 Michael Street, Atlanta, GA, 30322, USA.
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA.
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9
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Malt EA, Juhasz K, Frengen A, Wangensteen T, Emilsen NM, Hansen B, Agafonov O, Nilsen HL. Neuropsychiatric phenotype in relation to gene variants in the hemizygous allele in 3q29 deletion carriers: A case series. Mol Genet Genomic Med 2019; 7:e889. [PMID: 31347308 PMCID: PMC6732294 DOI: 10.1002/mgg3.889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/10/2019] [Accepted: 07/15/2019] [Indexed: 12/19/2022] Open
Abstract
Background Genetic risk variants in the hemizygous allele may influence neuropsychiatric manifestations and clinical course in 3q29 deletion carriers. Methods In‐depth phenotypic assessment in two deletion carriers included medical records, medical, genetic, psychiatric and neuropsychological evaluations, brain MRI scan and EEG. Blood samples were analyzed for copy number variations, and deep sequencing of the affected 3q29 region was performed in patients and seven first‐degree relatives. Risk variants were identified through bioinformatic analysis. Results One deletion carrier was diagnosed with learning difficulties and childhood autism, the other with mild intellectual disability and schizophrenia. EEG abnormalities in childhood normalized in adulthood in both. Cognitive abilities improved during adolescence in one deletion carrier. Both had microcytic, hypochromic erythrocytes and suffered from chronic pain and fatigue. Molecular and bioinformatic analyses identified risk variants in the hemizygous allele that were not present in the homozygous state in relatives in genes involved in cilia function and insulin action in the autistic individual and in synaptic function and neurosteroid transport in the subject with schizophrenia. Conclusion 3q29 deletion carriers may undergo developmental phenotypic transition and need regular medical follow‐up. Identified risk variants in the remaining hemizygous allele should be explored further in autism and schizophrenia research.
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Affiliation(s)
- Eva Albertsen Malt
- Department of Adult Habilitation, Akershus University Hospital, Lorenskog, Norway.,Campus Ahus, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Katalin Juhasz
- Department of Adult Habilitation, Akershus University Hospital, Lorenskog, Norway
| | - Anna Frengen
- Campus Ahus, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Section for Clinical Molecular Biology, Akershus University Hospital, Lorenskog, Norway
| | | | - Nina Merete Emilsen
- Department of Adult Habilitation, Akershus University Hospital, Lorenskog, Norway
| | - Borre Hansen
- Department of Adult Habilitation, Akershus University Hospital, Lorenskog, Norway
| | - Oleg Agafonov
- Bioinformatics Core Facility, Department of Core Facilities, Institute of Cancer Research, Radium Hospital, Part of Oslo University Hospital, Oslo, Norway
| | - Hilde Loge Nilsen
- Campus Ahus, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Section for Clinical Molecular Biology, Akershus University Hospital, Lorenskog, Norway
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10
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Pollak RM, Murphy MM, Epstein MP, Zwick ME, Klaiman C, Saulnier CA, Mulle JG. Neuropsychiatric phenotypes and a distinct constellation of ASD features in 3q29 deletion syndrome: results from the 3q29 registry. Mol Autism 2019; 10:30. [PMID: 31346402 PMCID: PMC6636128 DOI: 10.1186/s13229-019-0281-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 06/20/2019] [Indexed: 12/21/2022] Open
Abstract
Background The 1.6 Mb 3q29 deletion is associated with neurodevelopmental and psychiatric phenotypes, including increased risk for autism spectrum disorder (ASD) and a 20 to 40-fold increased risk for schizophrenia. However, the phenotypic spectrum of the deletion, particularly with respect to ASD, remains poorly described. Methods We ascertained individuals with 3q29 deletion syndrome (3q29Del, “cases,” n = 93, 58.1% male) and typically developing controls (n = 64, 51.6% male) through the 3q29 registry (https://3q29deletion.patientcrossroads.org). Self-report of neuropsychiatric illness was evaluated for 93 cases. Subsets of participants were evaluated with the Social Responsiveness Scale (SRS, n = 48 cases, 56 controls), Social Communication Questionnaire (n = 33 cases, 46 controls), Autism Spectrum Screening Questionnaire (n = 24 cases, 35 controls), and Achenbach Behavior Checklists (n = 48 cases, 57 controls). Results 3q29Del cases report a higher prevalence of autism diagnoses versus the general population (29.0% vs. 1.47%, p < 2.2E− 16). Notably, 3q29 deletion confers a greater influence on risk for ASD in females (OR = 41.8, p = 4.78E− 05) than in males (OR = 24.6, p = 6.06E− 09); this is aligned with the reduced male:female bias from 4:1 in the general population to 2:1 in our study sample. Although 71% of cases do not report a diagnosis of ASD, there is evidence of significant social disability (3q29Del SRS T-score = 71.8, control SRS T-score = 45.9, p = 2.16E− 13). Cases also report increased frequency of generalized anxiety disorder compared to controls (28.0% vs. 6.2%, p = 0.001), which is mirrored by elevated mean scores on the Achenbach diagnostic and statistical manual-oriented sub-scales (p < 0.001). Finally, cases show a distinct constellation of ASD features on the SRS as compared to idiopathic ASD, with substantially elevated Restricted Interests and Repetitive Behaviors, but only mild impairment in Social Motivation. Conclusions Our sample of 3q29Del is significantly enriched for ASD diagnosis, especially among females, and features of autism may be present even when an ASD diagnosis is not reported. Further, the constellation of ASD features in this population is distinct from idiopathic ASD, with substantially less impaired social motivation. Our study implies that ASD evaluation should be the standard of care for individuals with 3q29Del. From a research perspective, the distinct ASD subtype present in 3q29Del is an ideal entry point for expanding understanding of ASD. Electronic supplementary material The online version of this article (10.1186/s13229-019-0281-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rebecca M Pollak
- 1Genetics and Molecular Biology, Laney Graduate School, Emory University, Atlanta, USA
| | - Melissa M Murphy
- 2Department of Human Genetics, School of Medicine, Emory University, Atlanta, USA
| | - Michael P Epstein
- 2Department of Human Genetics, School of Medicine, Emory University, Atlanta, USA
| | - Michael E Zwick
- 2Department of Human Genetics, School of Medicine, Emory University, Atlanta, USA.,3Department of Pediatrics, School of Medicine, Emory University, Atlanta, USA
| | - Cheryl Klaiman
- 3Department of Pediatrics, School of Medicine, Emory University, Atlanta, USA.,4Marcus Autism Center, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, USA
| | - Celine A Saulnier
- 3Department of Pediatrics, School of Medicine, Emory University, Atlanta, USA
| | | | - Jennifer G Mulle
- 2Department of Human Genetics, School of Medicine, Emory University, Atlanta, USA.,5Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA.,Whitehead 305M, 615 Michael Street, Atlanta, GA 30322 USA
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11
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Murphy MM, Lindsey Burrell T, Cubells JF, España RA, Gambello MJ, Goines KCB, Klaiman C, Li L, Novacek DM, Papetti A, Sanchez Russo RL, Saulnier CA, Shultz S, Walker E, Mulle JG. Study protocol for The Emory 3q29 Project: evaluation of neurodevelopmental, psychiatric, and medical symptoms in 3q29 deletion syndrome. BMC Psychiatry 2018; 18:183. [PMID: 29884173 PMCID: PMC5994080 DOI: 10.1186/s12888-018-1760-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/22/2018] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND 3q29 deletion syndrome is caused by a recurrent hemizygous 1.6 Mb deletion on the long arm of chromosome 3. The syndrome is rare (1 in 30,000 individuals) and is associated with mild to moderate intellectual disability, increased risk for autism and anxiety, and a 40-fold increased risk for schizophrenia, along with a host of physical manifestations. However, the disorder is poorly characterized, the range of manifestations is not well described, and the underlying molecular mechanism is not understood. We designed the Emory 3q29 Project to document the range of neurodevelopmental and psychiatric manifestations associated with 3q29 deletion syndrome. We will also create a biobank of samples from our 3q29 deletion carriers for mechanistic studies, which will be a publicly-available resource for qualified investigators. The ultimate goals of our study are three-fold: first, to improve management and treatment of 3q29 deletion syndrome. Second, to uncover the molecular mechanism of the disorder. Third, to enable cross-disorder comparison with other rare genetic syndromes associated with neuropsychiatric phenotypes. METHODS We will ascertain study subjects, age 6 and older, from our existing registry ( 3q29deletion.org ). Participants and their families will travel to Atlanta, GA for phenotypic assessments, with particular emphasis on evaluation of anxiety, cognitive ability, autism symptomatology, and risk for psychosis via prodromal symptoms and syndromes. Evaluations will be performed using standardized instruments. Structural, diffusion, and resting-state functional MRI data will be collected from eligible study participants. We will also collect blood from the 3q29 deletion carrier and participating family members, to be banked at the NIMH Repository and Genomics Resource (NRGR). DISCUSSION The study of 3q29 deletion has the potential to transform our understanding of complex disease. Study of individuals with the deletion may provide insights into long term care and management of the disorder. Our project describes the protocol for a prospective study of the behavioral and clinical phenotype associated with 3q29 deletion syndrome. The paradigm described here could easily be adapted to study additional CNV or single gene disorders with high risk for neuropsychiatric phenotypes, and/or transferred to other study sites, providing a means for data harmonization and cross-disorder analysis.
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Affiliation(s)
- Melissa M. Murphy
- 0000 0001 0941 6502grid.189967.8Department of Human Genetics, Emory University School of Medicine, Whitehead Research Building, 615 Michael Street, Suite 300, Atlanta, GA 30322 USA
| | - T. Lindsey Burrell
- 0000 0001 0941 6502grid.189967.8Department of Pediatrics, Emory University School of Medicine, 1920 Briarcliff Road NE, Atlanta, GA 30322 USA ,0000 0004 0371 6071grid.428158.2Marcus Autism Center, 1920 Briarcliff Road NE, Atlanta, GA 30322 USA
| | - Joseph F. Cubells
- 0000 0001 0941 6502grid.189967.8Department of Human Genetics, Emory University School of Medicine, Whitehead Research Building, 615 Michael Street, Suite 300, Atlanta, GA 30322 USA ,Emory Autism Center, 1551 Shoup Court, Atlanta, GA 30322 USA ,0000 0001 0941 6502grid.189967.8Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive, 2nd floor, Atlanta, GA 30329 USA
| | - Roberto Antonio España
- 0000 0001 0941 6502grid.189967.8Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322 USA
| | - Michael J. Gambello
- 0000 0001 0941 6502grid.189967.8Department of Human Genetics, Emory University School of Medicine, Whitehead Research Building, 615 Michael Street, Suite 300, Atlanta, GA 30322 USA
| | - Katrina C. B. Goines
- 0000 0001 0941 6502grid.189967.8Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive, 2nd floor, Atlanta, GA 30329 USA ,0000 0001 0941 6502grid.189967.8Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322 USA
| | - Cheryl Klaiman
- 0000 0001 0941 6502grid.189967.8Department of Pediatrics, Emory University School of Medicine, 1920 Briarcliff Road NE, Atlanta, GA 30322 USA ,0000 0004 0371 6071grid.428158.2Marcus Autism Center, 1920 Briarcliff Road NE, Atlanta, GA 30322 USA
| | - Longchuan Li
- 0000 0001 0941 6502grid.189967.8Department of Pediatrics, Emory University School of Medicine, 1920 Briarcliff Road NE, Atlanta, GA 30322 USA ,0000 0004 0371 6071grid.428158.2Marcus Autism Center, 1920 Briarcliff Road NE, Atlanta, GA 30322 USA
| | - Derek M. Novacek
- 0000 0001 0941 6502grid.189967.8Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322 USA
| | - Ava Papetti
- 0000 0001 0941 6502grid.189967.8Department of Human Genetics, Emory University School of Medicine, Whitehead Research Building, 615 Michael Street, Suite 300, Atlanta, GA 30322 USA
| | - Rossana Lucia Sanchez Russo
- 0000 0001 0941 6502grid.189967.8Department of Human Genetics, Emory University School of Medicine, Whitehead Research Building, 615 Michael Street, Suite 300, Atlanta, GA 30322 USA
| | - Celine A. Saulnier
- 0000 0001 0941 6502grid.189967.8Department of Pediatrics, Emory University School of Medicine, 1920 Briarcliff Road NE, Atlanta, GA 30322 USA
| | - Sarah Shultz
- 0000 0001 0941 6502grid.189967.8Department of Pediatrics, Emory University School of Medicine, 1920 Briarcliff Road NE, Atlanta, GA 30322 USA ,0000 0004 0371 6071grid.428158.2Marcus Autism Center, 1920 Briarcliff Road NE, Atlanta, GA 30322 USA
| | - Elaine Walker
- 0000 0001 0941 6502grid.189967.8Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322 USA
| | - Jennifer Gladys Mulle
- Department of Human Genetics, Emory University School of Medicine, Whitehead Research Building, 615 Michael Street, Suite 300, Atlanta, GA, 30322, USA. .,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.
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12
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Glassford MR, Rosenfeld JA, Freedman AA, Zwick ME, Mulle JG. Novel features of 3q29 deletion syndrome: Results from the 3q29 registry. Am J Med Genet A 2016; 170A:999-1006. [PMID: 26738761 PMCID: PMC4849199 DOI: 10.1002/ajmg.a.37537] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 12/09/2015] [Indexed: 11/30/2022]
Abstract
3q29 deletion syndrome is caused by a recurrent, typically de novo heterozygous 1.6 Mb deletion, but because incidence of the deletion is rare (1 in 30,000 births) the phenotype is not well described. To characterize the range of phenotypic manifestations associated with 3q29 deletion syndrome, we have developed an online registry (3q29deletion.org) for ascertainment of study subjects and phenotypic data collection via Internet‐based survey instruments. We report here on data collected during the first 18 months of registry operation, from 44 patients. This is the largest cohort of 3q29 deletion carriers ever assembled and surveyed in a systematic way. Our data reveal that 28% of registry participants report neuropsychiatric phenotypes, including anxiety disorder, panic attacks, depression, bipolar disorder, and schizophrenia. Other novel findings include a high prevalence (64%) of feeding problems in infancy and reduced weight at birth for 3q29 deletion carriers (average reduction 13.9 oz (394 g), adjusted for gestational age and sex, P = 6.5e‐07). We further report on the frequency of heart defects, autism, recurrent ear infections, gastrointestinal phenotypes, and dental phenotypes, among others. We also report on the expected timing of delayed developmental milestones. This is the most comprehensive description of the 3q29 deletion phenotype to date. These results are clinically actionable toward improving patient care for 3q29 deletion carriers, and can guide the expectations of physicians and parents. These data also demonstrate the value of patient‐reported outcomes to reveal the full phenotypic spectrum of rare genomic disorders. © 2016 The Authors. American Journal of Medical Genetics Part A Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Megan R Glassford
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia
| | - Jill A Rosenfeld
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Alexa A Freedman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Michael E Zwick
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Jennifer G Mulle
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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