Bukowska-Olech Ewelina, Sowińska-Seidler Anna, Larysz Dawid, Gawliński Paweł, Koczyk Grzegorz, Popiel Delfina, Gurba-Bryśkiewicz Lidia, Materna-Kiryluk Anna, Adamek Zuzanna, Szczepankiewicz Aleksandra, Dominiak Paweł, Glista Filip, Matuszewska Karolina, Jamsheer Aleksander
Department of Medical Genetics, Poznan University of Medical Sciences, Poznan, Poland.
Department of Head and Neck Surgery for Children and Adolescents, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland.
Front Mol Biosci. 2022 Apr 28;9:865494. doi: 10.3389/fmolb.2022.865494. eCollection 2022.
Craniosynostosis (CS) represents a highly heterogeneous genetic condition whose genetic background has not been yet revealed. The abnormality occurs either in isolated form or syndromic, as an element of hundreds of different inborn syndromes. Consequently, CS may often represent a challenging diagnostic issue. We investigated a three-tiered approach (karyotyping, Sanger sequencing, followed by custom gene panel/chromosomal microarray analysis, and exome sequencing), coupled with prioritization of variants based on dysmorphological assessment and description in terms of human phenotype ontology. In addition, we have also performed a statistical analysis of the obtained clinical data using the nonparametric test χ. We achieved a 43% diagnostic success rate and have demonstrated the complexity of mutations' type harbored by the patients, which were either chromosomal aberrations, copy number variations, or point mutations. The majority of pathogenic variants were found in the well-known CS genes, however, variants found in genes associated with chromatinopathies or RASopathies are of particular interest. We have critically summarized and then optimised a cost-effective diagnostic algorithm, which may be helpful in a daily diagnostic routine and future clinical research of various CS types. Moreover, we have pinpointed the possible underestimated co-occurrence of CS and intellectual disability, suggesting it may be overlooked when intellectual disability constitutes a primary clinical complaint. On the other hand, in any case of already detected syndromic CS and intellectual disability, the possible occurrence of clinical features suggestive for chromatinopathies or RASopathies should also be considered.
颅缝早闭(CS)是一种高度异质性的遗传疾病,其遗传背景尚未明确。这种异常情况既可以以孤立形式出现,也可以作为数百种不同先天性综合征的一个组成部分以综合征形式出现。因此,CS常常可能是一个具有挑战性的诊断问题。我们研究了一种三层方法(核型分析、桑格测序,随后进行定制基因panel/染色体微阵列分析和外显子组测序),并结合基于畸形评估和人类表型本体描述对变异进行优先级排序。此外,我们还使用非参数检验χ对获得的临床数据进行了统计分析。我们获得了43%的诊断成功率,并证明了患者所携带的突变类型的复杂性,这些突变类型包括染色体畸变、拷贝数变异或点突变。大多数致病变异存在于已知的CS基因中,然而,在与染色质病或RAS病相关的基因中发现的变异尤其令人感兴趣。我们批判性地总结并优化了一种具有成本效益的诊断算法,该算法可能有助于各种CS类型的日常诊断常规和未来临床研究。此外,我们还指出了CS与智力残疾可能被低估的共现情况,表明当智力残疾构成主要临床症状时,这种情况可能会被忽视。另一方面,在任何已检测到的综合征性CS和智力残疾的病例中,也应考虑可能出现的提示染色质病或RAS病的临床特征。