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通过全外显子组测序探索初诊为 Rubinstein-Taybi 综合征的患者:表观遗传机制障碍的相互联系。

Exploring by whole exome sequencing patients with initial diagnosis of Rubinstein-Taybi syndrome: the interconnections of epigenetic machinery disorders.

机构信息

Genetica Medica, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.

U.O. Genetica Medica, Policlinico S. Orsola-Malpighi, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.

出版信息

Hum Genet. 2019 Mar;138(3):257-269. doi: 10.1007/s00439-019-01985-y. Epub 2019 Feb 26.

Abstract

Rubinstein-Taybi syndrome (RSTS) is an autosomal-dominant neurodevelopmental disease affecting 1:125,000 newborns characterized by intellectual disability, growth retardation, facial dysmorphisms and skeletal abnormalities. RSTS is caused by mutations in genes encoding for writers of the epigenetic machinery: CREBBP (~ 60%) or its homologous EP300 (~ 10%). No causative mutation is identified in up to 30% of patients. We performed whole-exome sequencing (WES) on eight RSTS-like individuals who had normal high-resolution array CGH testing and were CREBBP- and EP300-mutation -negative, to identify the molecular cause. In four cases, we identified putatively causal variants in three genes (ASXL1, KMT2D and KMT2A) encoding members of the epigenetic machinery known to be associated with the Bohring-Opitz, Kabuki and Wiedemann-Steiner syndromes. Each variant is novel, de novo, fulfills the ACMG criteria and is predicted to result in loss-of-function leading to haploinsufficiency of the epi-gene. In two of the remaining cases, homozygous/compound heterozygous variants in XYLT2 and PLCB4 genes, respectively, associated with spondyloocular and auriculocondylar 2 syndromes and in the latter an additional candidate variant in XRN2, a gene yet unrelated to any disease, were detected, but their pathogenicity remains uncertain. These results underscore the broad clinical spectrum of Mendelian disorders of the epigenetic apparatus and the high rate of WES disclosure of the genetic basis in cases which may pose a challenge for phenotype encompassing distinct syndromes. The overlapping features of distinct intellectual disability syndromes reflect common pathogenic molecular mechanisms affecting the complex regulation of balance between open and closed chromatin.

摘要

鲁宾斯坦-泰比综合征(RSTS)是一种常染色体显性神经发育疾病,影响每 125,000 名新生儿中的 1 名,其特征为智力残疾、生长迟缓、面部畸形和骨骼异常。RSTS 是由表观遗传机制的写入器基因(CREBBP[60%]或其同源物 EP300[10%])的突变引起的。高达 30%的患者未发现致病突变。我们对 8 名具有正常高分辨率阵列 CGH 检测且 CREBBP 和 EP300 突变阴性的 RSTS 样个体进行了全外显子组测序(WES),以确定分子病因。在 4 个病例中,我们在 3 个基因(ASXL1、KMT2D 和 KMT2A)中鉴定出了假定的因果变异,这些基因编码的成员已知与 Bohring-Opitz、Kabuki 和 Wiedemann-Steiner 综合征有关。每个变异都是新的、从头出现的,符合 ACMG 标准,预计会导致功能丧失,从而导致表观基因的单倍不足。在其余的 2 个病例中,分别在 XYLT2 和 PLCB4 基因中检测到纯合/复合杂合变异,这些变异与脊椎-眼综合征和耳-软骨 2 综合征有关,在后一个病例中,还在 XRN2 基因中检测到了另一个候选变异,该基因与任何疾病均无关,但它们的致病性仍不确定。这些结果强调了表观遗传装置的孟德尔疾病的广泛临床谱,以及 WES 揭示可能对包含不同综合征的表型构成挑战的病例的遗传基础的高比例。不同智力残疾综合征的重叠特征反映了影响开放和闭合染色质之间平衡的复杂调节的常见致病分子机制。

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