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Mirzaa G, Timms AE, Conti V, Boyle EA, Girisha KM, Martin B, Kircher M, Olds C, Juusola J, Collins S, Park K, Carter M, Glass I, Krägeloh-Mann I, Chitayat D, Parikh AS, Bradshaw R, Torti E, Braddock S, Burke L, Ghedia S, Stephan M, Stewart F, Prasad C, Napier M, Saitta S, Straussberg R, Gabbett M, O'Connor BC, Keegan CE, Yin LJ, Lai AHM, Martin N, McKinnon M, Addor MC, Boccuto L, Schwartz CE, Lanoel A, Conway RL, Devriendt K, Tatton-Brown K, Pierpont ME, Painter M, Worgan L, Reggin J, Hennekam R, Tsuchiya K, Pritchard CC, Aracena M, Gripp KW, Cordisco M, Van Esch H, Garavelli L, Curry C, Goriely A, Kayserilli H, Shendure J, Graham J, Guerrini R, Dobyns WB. PIK3CA-associated developmental disorders exhibit distinct classes of mutations with variable expression and tissue distribution. JCI Insight 2018; 1:87623. [PMID: 27631024 PMCID: PMC5019182 DOI: 10.1172/jci.insight.87623] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Mosaicism is increasingly recognized as a cause of developmental disorders with the advent of next-generation sequencing (NGS). Mosaic mutations of PIK3CA have been associated with the widest spectrum of phenotypes associated with overgrowth and vascular malformations. We performed targeted NGS using 2 independent deep-coverage methods that utilize molecular inversion probes and amplicon sequencing in a cohort of 241 samples from 181 individuals with brain and/or body overgrowth. We identified PIK3CA mutations in 60 individuals. Several other individuals (n = 12) were identified separately to have mutations in PIK3CA by clinical targeted-panel testing (n = 6), whole-exome sequencing (n = 5), or Sanger sequencing (n = 1). Based on the clinical and molecular features, this cohort segregated into three distinct groups: (a) severe focal overgrowth due to low-level but highly activating (hotspot) mutations, (b) predominantly brain overgrowth and less severe somatic overgrowth due to less-activating mutations, and (c) intermediate phenotypes (capillary malformations with overgrowth) with intermediately activating mutations. Sixteen of 29 PIK3CA mutations were novel. We also identified constitutional PIK3CA mutations in 10 patients. Our molecular data, combined with review of the literature, show that PIK3CA-related overgrowth disorders comprise a discontinuous spectrum of disorders that correlate with the severity and distribution of mutations. The clinical and molecular spectrum of PIK3CA-related developmental disorders are correlated with types of mutations, tissue distributions, and levels of mosaicism with the clinical phenotype.
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Affiliation(s)
- Ghayda Mirzaa
- Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA.,Center for Integrative Brain Research and
| | - Andrew E Timms
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Valerio Conti
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, Neuroscience Department, A. Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Evan August Boyle
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA
| | - Katta M Girisha
- Department of Medical Genetics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Beth Martin
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
| | - Martin Kircher
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
| | | | - Jane Juusola
- Whole Exome Sequencing Program, GeneDx, Gaithersburg, Maryland, USA
| | | | | | - Melissa Carter
- Regional Genetics Program, The Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Ian Glass
- Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA.,Center for Integrative Brain Research and
| | - Inge Krägeloh-Mann
- Department of Pediatrics, and Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany
| | - David Chitayat
- Mount Sinai Hospital, The Prenatal Diagnosis and Medical Genetics Division, Department of Obstetrics and Gynecology, and.,Department of Pediatrics, Division of Clinical and Metabolic Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Aditi Shah Parikh
- Center for Human Genetics, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Rachael Bradshaw
- Department of Pediatrics, Division of Medical Genetics, Saint Louis University, St. Louis, Missouri, USA
| | - Erin Torti
- Department of Pediatrics, Division of Medical Genetics, Saint Louis University, St. Louis, Missouri, USA
| | - Stephen Braddock
- Department of Pediatrics, Division of Medical Genetics, Saint Louis University, St. Louis, Missouri, USA
| | - Leah Burke
- Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vermont, USA
| | - Sondhya Ghedia
- Department of Clinical Genetics, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Mark Stephan
- Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Fiona Stewart
- Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Chitra Prasad
- Genetics, Metabolism and Pediatrics, London, Ontario, Canada
| | - Melanie Napier
- Genetics, Metabolism and Pediatrics, London, Ontario, Canada
| | - Sulagna Saitta
- Clinical Genetics, Center for Personalized Medicine, Children's Hospital Los Angeles, Keck School of Medicine at University of Southern California, Los Angeles, California, USA
| | - Rachel Straussberg
- Neurology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Gabbett
- School of Medicine, Griffith University, Brisbane, Queensland, Australia
| | - Bridget C O'Connor
- Division of Genetics, Department of Pediatrics, and.,Department of Human Genetics, University of Michigan, Ann Arbor, Michigan, USA
| | - Catherine E Keegan
- Division of Genetics, Department of Pediatrics, and.,Department of Human Genetics, University of Michigan, Ann Arbor, Michigan, USA
| | - Lim Jiin Yin
- Genetics Service, Department of Pediatric Medicine, KK Women's and Children's Hospital, Singapore
| | - Angeline Hwei Meeng Lai
- Genetics Service, Department of Pediatric Medicine, KK Women's and Children's Hospital, Singapore
| | - Nicole Martin
- Department of Pediatrics, Division of Clinical and Metabolic Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Margaret McKinnon
- British Columbia Medical Genetics Provincial Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marie-Claude Addor
- Service de génétique médicale, Centre Hospitalier Universitaire Vaudois CHUV, Switzerland
| | - Luigi Boccuto
- Greenwood Genetic Center, Greenwood, South Carolina, USA
| | | | - Agustina Lanoel
- Department of Dermatology, Children Hospital Prof. Dr. J. P. Garrahan, Buenos Aires, Argentina
| | - Robert L Conway
- Children's Hospital of Michigan, Wayne State University, Detroit, Michigan, USA
| | - Koenraad Devriendt
- Center for Human Genetics, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Katrina Tatton-Brown
- South West Thames Regional Genetics Service, St George's University NHS Foundation Trust, London, and Section of Cancer Genetics, Institute of Cancer Research, Sutton, United Kingdom
| | - Mary Ella Pierpont
- Department of Pediatrics and Ophthalmology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael Painter
- Department of Child Neurology, University of Florida, Jacksonville, Florida, USA
| | - Lisa Worgan
- Department of Genetics, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - James Reggin
- Department of Neurology, University of Washington, Seattle, Washington, USA.,Providence Child Neurology, Providence Sacred Heart Medical Center and Children's Hospital, Spokane, Washington, USA
| | - Raoul Hennekam
- Department of Pediatrics and Translational Genetics, Department of Pediatrics, Academic Medical Center, University of Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Karen Tsuchiya
- Department of Laboratories, Seattle Children's Hospital and.,Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Colin C Pritchard
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Mariana Aracena
- División de Pediatría, Pontificia Universidad Católica de Chile, Pediatra-Genetista, Unidad de Genética, Hospital Dr. Luis Calvo Mackenna, Santiago, Chile
| | - Karen W Gripp
- Department of Pediatrics, Sidney Kimmel Medical School at T. Jefferson University, Chief of Division of Medical Genetics, A.I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Maria Cordisco
- Departments of Dermatology and Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Hilde Van Esch
- Center for Human Genetics, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Livia Garavelli
- Clinical Genetics Unit, IRCCS Santa Maria Nuova Hospital, Reggio Emilia, Italy
| | - Cynthia Curry
- University of California, San Francisco, San Francisco/Genetic Medicine Central California, San Francisco, California, USA
| | - Anne Goriely
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Hulya Kayserilli
- Koç University, School of Medicine, Medical Genetics Department, Koç University Hospital, Istanbul, Turkey
| | - Jay Shendure
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA.,Howard Hughes Medical Institute, Seattle, Washington, USA
| | - John Graham
- Department of Pediatrics, Cedars-Sinai Medical Center, Harbor-UCLA Medical Center, David Geffen School of Medicine Los Angeles, California, USA
| | - Renzo Guerrini
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, Neuroscience Department, A. Meyer Children's Hospital, University of Florence, Florence, Italy
| | - William B Dobyns
- Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA.,Center for Integrative Brain Research and.,Department of Neurology, University of Washington, Seattle, Washington, USA
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