Nottingham Clinical Genetics Service, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
Adv Genet. 2019;103:163-182. doi: 10.1016/bs.adgen.2018.11.001. Epub 2018 Dec 11.
Mutations in CDK13 have recently been identified as a novel cause of syndromic intellectual disability. In this chapter, we review the 44 cases of CDK13-related disorder reported to date, highlighting key clinical pointers to this diagnosis including characteristic craniofacial features, feeding difficulties in infancy, and the presence of structural heart or brain malformations. The spectrum of reported mutations is also described, demonstrating an excess of missense mutations arising in the protein kinase domain. Exploration of genotype-phenotype correlations suggests a trend toward milder phenotypes in patients with mutations predicted to cause haploinsufficiency of CDK13, while missense mutations affecting amino acid residue 842 appear most likely to be associated with structural malformations. The greater phenotypic impact of missense variants is hypothesized to occur due to a dominant-negative mechanism, by which the mutant protein acts to sequester cyclin K in inactive complexes. Functional studies to validate this hypothesis have not yet been carried out, however. Differential diagnosis and recommendations for clinical care of patients with CDK13-related disorder are also described, emphasizing baseline echocardiography, vigilance for feeding and swallowing difficulties, and regular developmental evaluation as key components of care. Finally, future directions for CDK13 research are discussed, including the need to resolve uncertainty regarding pathogenicity of CDK13 haploinsufficiency, and to gather further longitudinal data from large cohorts in order to inform the clinical care of patients with this diagnosis.
CDK13 基因突变最近被确定为一种新的综合征性智力障碍的病因。在本章中,我们回顾了迄今为止报道的 44 例 CDK13 相关疾病的病例,强调了这一诊断的关键临床要点,包括特征性的颅面特征、婴儿期喂养困难以及存在结构性心脏或脑畸形。还描述了报道的突变谱,表明在蛋白激酶结构域中存在大量错义突变。对基因型-表型相关性的探索表明,预测 CDK13 杂合不足的患者的表型趋于较轻,而影响 842 号氨基酸残基的错义突变似乎最有可能与结构性畸形相关。错义变异体的更大表型影响被假设是由于显性负机制发生的,其中突变蛋白将细胞周期蛋白 K 隔离在无活性复合物中。然而,尚未进行验证该假设的功能研究。还描述了 CDK13 相关疾病患者的鉴别诊断和临床护理建议,强调了基线超声心动图、对喂养和吞咽困难的警惕性以及定期发育评估作为护理的关键组成部分。最后,讨论了 CDK13 研究的未来方向,包括需要解决 CDK13 杂合不足的致病性的不确定性,并从大队列中收集进一步的纵向数据,以便为这一诊断的患者提供临床护理。