Efthymiou Stephanie, Manole Andreea, Houlden Henry
aDepartment of Molecular NeurosciencebMRC Centre for Neuromuscular Diseases.
Curr Opin Neurol. 2016 Oct;29(5):527-36. doi: 10.1097/WCO.0000000000000374.
Neuromuscular diseases are clinically and genetically heterogeneous and probably contain the greatest proportion of causative Mendelian defects than any other group of conditions. These disorders affect muscle and/or nerves with neonatal, childhood or adulthood onset, with significant disability and early mortality. Along with heterogeneity, unidentified and often very large genes require complementary and comprehensive methods in routine molecular diagnosis. Inevitably, this leads to increased diagnostic delays and challenges in the interpretation of genetic variants.
The application of next-generation sequencing, as a research and diagnostic strategy, has made significant progress into solving many of these problems. The analysis of these data is by no means simple, and the clinical input is essential to interpret results.
In this review, we describe using examples the recent advances in the genetic diagnosis of neuromuscular disorders, in research and clinical practice and the latest developments that are underway in next-generation sequencing. We also discuss the latest collaborative initiatives such as the Genomics England (Department of Health, UK) genome sequencing project that combine rare disease clinical phenotyping with genomics, with the aim of defining the vast majority of rare disease genes in patients as well as modifying risks and pharmacogenomics factors.
神经肌肉疾病在临床和遗传方面具有异质性,与其他任何疾病组相比,其可能包含的孟德尔致病缺陷比例最高。这些疾病会影响肌肉和/或神经,发病于新生儿期、儿童期或成年期,导致严重残疾和早期死亡。除了异质性之外,未明确且通常非常大的基因需要在常规分子诊断中采用互补且全面的方法。不可避免地,这会导致诊断延迟增加以及在解释基因变异方面面临挑战。
作为一种研究和诊断策略,下一代测序技术的应用在解决许多此类问题方面取得了重大进展。对这些数据的分析绝非易事,临床投入对于解释结果至关重要。
在本综述中,我们通过实例描述了神经肌肉疾病基因诊断在研究和临床实践中的最新进展以及下一代测序技术的最新发展情况。我们还讨论了最新的合作计划,如英国卫生部的基因组英格兰项目,该项目将罕见病临床表型分析与基因组学相结合,旨在确定患者中绝大多数罕见病基因,并修改风险和药物基因组学因素。