Schueler Markus, Halbritter Jan, Phelps Ian G, Braun Daniela A, Otto Edgar A, Porath Jonathan D, Gee Heon Yung, Shendure Jay, O'Roak Brian J, Lawson Jennifer A, Nabhan Marwa M, Soliman Neveen A, Doherty Dan, Hildebrandt Friedhelm
Divison of Nephology, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Divison of Nephology, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA Divison of Nephrology, Department of Internal Medicine, University Clinic Leipzig, Leipzig, Germany.
J Med Genet. 2016 Mar;53(3):208-14. doi: 10.1136/jmedgenet-2015-103304. Epub 2015 Dec 16.
BACKGROUND: The term nephronophthisis-related ciliopathies (NPHP-RC) describes a group of rare autosomal-recessive cystic kidney diseases, characterised by broad genetic and clinical heterogeneity. NPHP-RC is frequently associated with extrarenal manifestations and accounts for the majority of genetically caused chronic kidney disease (CKD) during childhood and adolescence. Generation of a molecular diagnosis has been impaired by this broad genetic heterogeneity. However, recently developed high-throughput exon sequencing techniques represent powerful and efficient tools to screen large cohorts for dozens of causative genes. METHODS: Therefore, we performed massively multiplexed targeted sequencing using the modified molecular inversion probe strategy (MIPs) in an international cohort of 384 patients diagnosed with NPHP-RC. RESULTS: As a result, we established the molecular diagnoses in 81/384 unrelated individuals (21.1%). We detected 127 likely disease-causing mutations in 18 of 34 evaluated NPHP-RC genes, 22 of which were novel. We further compared a subgroup of current findings to the results of a previous study in which we used an array-based microfluidic PCR technology in the same cohort. While 78 likely disease-causing mutations were previously detected by the array-based microfluidic PCR, the MIPs approach identified 94 likely pathogenic mutations. Compared with the previous approach, MIPs redetected 66 out of 78 variants and 28 previously unidentified variants, for a total of 94 variants. CONCLUSIONS: In summary, we demonstrate that the modified MIPs technology is a useful approach to screen large cohorts for a multitude of established NPHP genes in order to identify the underlying molecular cause. Combined application of two independent library preparation and sequencing techniques, however, may still be indicated for Mendelian diseases with extensive genetic heterogeneity in order to further increase diagnostic sensitivity.
背景:肾单位肾痨相关纤毛病(NPHP-RC)这一术语描述了一组罕见的常染色体隐性遗传性囊性肾病,其特点是具有广泛的遗传和临床异质性。NPHP-RC常伴有肾外表现,是儿童和青少年期遗传性慢性肾脏病(CKD)的主要病因。这种广泛的遗传异质性阻碍了分子诊断的产生。然而,最近开发的高通量外显子测序技术是筛查大量人群中数十个致病基因的强大而有效的工具。 方法:因此,我们采用改良的分子反向探针策略(MIPs),对384例诊断为NPHP-RC的国际患者队列进行了大规模多重靶向测序。 结果:结果,我们在81/384名无亲缘关系的个体(21.1%)中确立了分子诊断。我们在34个评估的NPHP-RC基因中的18个基因中检测到127个可能致病的突变,其中22个是新发现的。我们进一步将当前研究的一个亚组结果与之前一项研究的结果进行了比较,在之前的研究中,我们在同一队列中使用了基于微流控芯片的PCR技术。虽然之前通过基于微流控芯片的PCR检测到78个可能致病的突变,但MIPs方法鉴定出94个可能致病的突变。与之前的方法相比,MIPs重新检测到了78个变异中的66个以及28个之前未鉴定出的变异,共计94个变异。 结论:总之,我们证明改良的MIPs技术是一种有用的方法,可用于在大量人群中筛查众多已确定的NPHP基因,以确定潜在的分子病因。然而,对于具有广泛遗传异质性的孟德尔疾病,可能仍需联合应用两种独立的文库制备和测序技术,以进一步提高诊断敏感性。
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