A novel detrimental homozygous mutation in the WFS1 gene in two sisters from nonconsanguineous parents with untreated diabetes insipidus

Given the limited lifespan and with the recent progress in experimental treatments for WS, timely diagnosis and multidisciplinary treatment for DI/DM, hydronephrosis, and visual/psychiatric status-maintaining quality of life-are of crucial importance

A novel Desmoplakin mutation associated with left dominant arrhythmogenic cardiomyopathy and cutaneous phenotype

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Complex chromosome rearrangement in a child with microcephaly, dysmorphic facial features and mosaicism for a terminal deletion del(18)(q21.32-qter) investigated by FISH and array-CGH: Case report

We report on a 7 years and 4 months old Greek boy with mild microcephaly and dysmorphic facial features. He was a sociable child with maxillary hypoplasia, epicanthal folds, upslanting palpebral fissures with long eyelashes, and hypertelorism. His ears were prominent and dysmorphic, he had a long philtrum and a high arched palate. His weight was 17 kg (25th percentile) and his height 120 cm (50th percentile). High resolution chromosome analysis identified in 50% of the cells a normal male karyotype, and in 50% of the cells one chromosome 18 showed a terminal deletion from 18q21.32. Molecular cytogenetic investigation confirmed a del(18)(q21.32-qter) in the one chromosome 18, but furthermore revealed the presence of a duplication in q21.2 in the other chromosome 18. The case is discussed concerning comparable previously reported cases and the possible mechanisms of formation

Prenatal diagnosis of Wolf-Hirschhorn syndrome confirmed by comparative genomic hybridization array: report of two cases and review of the literature

Wolf-Hirschhorn syndrome (WHS) is a well known genetic condition caused by a partial deletion of the short arm of chromosome 4. The great variability in the extent of the 4p deletion and the possible contribution of additional genetic rearrangements lead to a wide spectrum of clinical manifestations. The majority of the reports of prenatally diagnosed WHS cases are associated with large 4p deletions identified by conventional chromosome analysis; however, the widespread clinical use of novel molecular techniques such as array comparative genomic hybridization (a-CGH) has increased the detection rate of submicroscopic chromosomal aberrations associated with WHS phenotype. We provide a report of two fetuses with WHS presenting with intrauterine growth restriction as an isolated finding or combined with oligohydramnios and abnormal Doppler waveform in umbilical artery and uterine arteries. Standard karyotyping demonstrated a deletion on chromosome 4 in both cases [del(4)(p15.33) and del(4)(p15.31), respectively] and further application of a-CGH confirmed the diagnosis and offered a precise characterization of the genetic defect. A detailed review of the currently available literature on the prenatal diagnostic approach of WHS in terms of fetal sonographic assessment and molecular cytogenetic investigation is also provided

Detailed molecular and clinical investigation of a child with a partial deletion of chromosome 11 (Jacobsen syndrome)

<p>Abstract</p> <p>Background</p> <p>Jacobsen syndrome (JBS) is a rare chromosomal disorder leading to multiple physical and mental impairment. This syndrome is caused by a partial deletion of chromosome 11, especially subband 11q24.1 has been proven to be involved. Clinical cases may easily escape diagnosis, however pancytopenia or thrombocytopenia may be indicative for JBS.</p> <p>Results</p> <p>We report a 7.5 years old boy presenting with speech development delay, hearing impairment and abnormal platelet function. High resolution SNP oligonucleotide microarray analysis revealed a terminal deletion of 11.4 Mb in size, in the area 11q24.1-11qter. This specific deletion encompasses around 170 genes. Other molecular techniques such as fluorescence in situ hybridization and multiplex ligation-dependent probe amplification were used to confirm the array-result.</p> <p>Discussion</p> <p>Our results suggest that the identification and detailed analysis of similar patients with abnormal platelet function and otherwise mild clinical features will contribute to identification of more patients with 11q deletion and JBS.</p

Combined 22q11.1-q11.21 deletion with 15q11.2-q13.3 duplication identified by array-CGH in a 6 years old boy

<p>Abstract</p> <p>Background</p> <p>Deletions of chromosome 22q11 are present in over 90% of cases of DiGeorge or Velo-Cardio-Facial syndrome (DGS/VCFS). 15q11-q13 duplication is another recognized syndrome due to rearrangements of several genes, belonging to the category of imprinted genes. The phenotype of this syndrome varies but has been clearly associated with developmental delay and autistic spectrum disorders. Co-existence of the two syndromes has not been reported so far.</p> <p>Results</p> <p>Here we report a 6-year-old boy presenting growth retardation, dysmorphic features and who exhibited learning difficulties. Fluorescence in situ hybridization (FISH) analysis of the proband revealed a deletion of DiGeorge Syndrome critical region (TUPLE). Array-CGH analysis revealed an interstitial duplication of 12 Mb in size in the area 15q11.2-q13.3, combined with a 3.2 Mb deletion at region 22q11.1-q11.21. FISH analysis in the mother showed a cryptic balanced translocation between chromosome 15 and chromosome 22 (not evident by classic karyotyping).</p> <p>Discusion</p> <p>The clinical manifestations could be related to both syndromes and the importance of array-CGH analysis in cases of unexplained developmental delay is emphasized. The present case further demonstrates how molecular cytogenetic techniques applied in the parents were necessary for the genetic counseling of the family.</p

The use of array-CGH in a cohort of Greek children with developmental delay

<p>Abstract</p> <p>Background</p> <p>The genetic diagnosis of mental retardation (MR) is difficult to establish and at present many cases remain undiagnosed and unexplained. Standard karyotyping has been used as one of the routine techniques for the last decades. The implementation of Array Comparative Genomic Hybridization (array-CGH) has enabled the analysis of copy number variants (CNVs) with high resolution. Major cohort studies attribute 11% of patients with unexplained mental retardation to clinically significant CNVs. Here we report the use of array-CGH for the first time in a Greek cohort. A total of 82 children of Greek origin with mean age 4.9 years were analysed in the present study. Patients with visible cytogenetic abnormalities ascertained by standard karyotyping as well as those with subtelomeric abnormalities determined by Multiplex Ligation-dependent Probe Amplification (MLPA) or subtelomeric FISH had been excluded.</p> <p>Results</p> <p>Fourteen CNVs were detected in the studied patients. In nine patients (11%) the chromosomal aberrations were inherited from one of the parents. One patients showed two duplications, a 550 kb duplication in 3p14.1 inherited from the father and a ~1.1 Mb duplication in (22)(q13.1q13.2) inherited from the mother. Although both parents were phenotypically normal, it cannot be excluded that the dual duplication is causative for the patient's clinical profile including dysmorphic features and severe developmental delay. Furthermore, three <it>de novo </it>clinically significant CNVs were detected (3.7%). There was a ~6 Mb triplication of 18q21.1 in a girl 5 years of age with moderate MR and mild dysmorphic features and a ~4.8 Mb duplication at (10)(q11.1q11.21) in a 2 years old boy with severe MR, multiple congenital anomalies, severe central hypotonia, and ataxia. Finally, in a 3 year-old girl with microcephaly and severe hypotonia a deletion in (2)(q31.2q31.3) of about ~3.9 Mb was discovered. All CNVs were confirmed by Fluorescence <it>in situ </it>hybridization (FISH). For the remaining 9 patients the detected CNVs (inherited duplications or deletions of 80 kb to 800 kb in size) were probably not associated with the clinical findings.</p> <p>Conclusions</p> <p>Genomic microarrays have within the recent years proven to be a highly useful tool in the investigation of unexplained MR. The cohorts reported so far agree on an around 11% diagnostic yield of clinically significant CNVs in patients with unexplained MR. Various publicly available databases have been created for the interpretation of identified CNVs and parents are analyzed in case a rare CNV is identified in the child. We have conducted a study of Greek patients with unexplained MR and confirmed the high diagnostic value of the previous studies. It is important that the technique becomes available also in less developed countries when the cost of consumables will be reduced.</p

Characterization of small supernumerary markers chromosome in prenatal diagnosis

Small supernumerary marker chromosomes (sSMCs) are defined as structural chromosomal abnormalities of equal or smaller size than chromosome 20 that can not be characterised and identified by classical cytogenetic techniques. A sSMC can appear in a karyotype with (1) 46 normal chromosomes, (2) numerical aneuploides (e.g. Turner syndrome or Down syndrome) or (3) in balanced translocations. The sSMCs appear with an incidence of 0.075% in random cases of prenatal screening while merely 0.044% in postnatal cases. The incidence of sSMCs in cases of prenatal screening with having ultrasound abnormalities is at least five times greater than in neonates and at least three times greater whom compared to random prenatal screening cases. Furthermore 0.288% of patients with neuro/developmental retardation have a sSMC. Approximately 70% of de novo sSMCs in prenatal screening cases have no phenotypical manifestations. The risk for phenotypic abnormalities in cases of prenatal screening detection amounts to approximately 13%. That is depends on the origin of the marker chromosome as well as on whether this is appearing for the first time in that embryo (de novo) or familial. The risk can vary from 7% when the de novo sSMC comes from chromosomes 13, 14, 15, 21 and 22 and is up to 28% for non-acrocentric chromosomes. In addition more than 98% of hereditary sSMCs are without phenotypic consequence. In prenatal screening, however, 16% of sSMCs have clinical consequences. In particular the risk for phenotypic abnormalities for sSMCs that originate from acrocentric chromosomes amounts to 10.9% and up to 14% for non-acrocentric sSMCs. We do not know a great deal about on to the exact mechanism of sSMC formation and in particular it is unclear where, when and why, an sSMC is created during gametogenesis or embryogenesis. However there are various models of how the various types of sSMCs are created. These theories are based on findings from UPD (uni parental disomy) studies and on the observation that sSMCs can be created from incomplete correction of a trisomy. In general a sSMC is created by the additive effect of two or more incidents during gametogenesis or embryogenesis.Usually the presence of an sSMC in a patient is confirmed using chromosomal banding from peripheral blood sample, amniotic fluid or chorionic villus samples. If cytogenetic analysis reveals an sSMC, then this has to be further characterised using molecular cytogenetic techniques. Today with the development of molecular cytogenetics and the use of array-CGH almost all chromosomal imbalances can be characterised. The aim of this study was to fully investigate sSMCs that are found in prenatal samples so that the right prognosis as well as genetic counselling can be given. The ultimate goal of the study was to correlate the genotype with the phenotype and in particular with the ultrasound findings as well as the clinical picture of the neonates in cases of continued pregnancies. The research work focused on characterising and identifying marker chromosomes in samples of prenatal screening and concurrently studying the presence or absence of euchromatic regions utilising classical cytogenetic and molecular cytogenetic techniques (fluorescent in situ hybridization (FISH) and array- CGH). At the same time the presence or absence of uniparental disomy (UPD) was studied, focusing on marker chromosomes whose origin came from chromosomes involved in monogenic disomy. For this reason a molecular analysis for the presence or absence of UPD was performed in sSMC cases with a high risk for UPD. A total 42 sSMCs where successfully characterised, drawn from approximately 50,000 prenatal samples of amniotic fluid and chorionic villi. The results of the current study confirmed the contribution of molecular cytogenetic techniques (FISH and Array-CGH) towards the precise characterisation of sSMCs identified during prenatal screening. By utilising FISH and array-CGH we were able to successfully characterise all 42 sSMCs that where detected using classical cytogenetic techniques. On top of the chromosomal origin of the sSMC we identified the presence or absence, size of euchromatin as well as its constituent genes. In total 19/42 (45%) of cases this study are connected with important clinical findings, resulting in accurate genetic counselling for the couples.In the current study if we had utilised only array-CGH technique we would have missed 16 cases of sSMCs that were comprised exclusively from heterochromatic material. In 12/16 cases the sSMC originated from chromosomes for which UPD analysis was necessary. Conversely non utilisation of array-CGH would not reveal the complexity of some sSMCs. In addition it are us the possibility for a detailed characterisation of these sSMCs as a result of which a clearer view of the prognosis and genetic counselling was obtained. The extended practice of array-CGH will reveal more surprises and an possibly differentiate the opinion for the exact composition of supernumerary chromosomal markers.In conclusion molecular cytogenetics (FISH, array-CGH) in combination with other molecular techniques (UPD) can provide valuable information regarding the chromosomal origin and composition of marker chromosomes in prenatal diagnosis. With the advent of new technologies, like array-CGH, it will be possible to fully characterise the genetic components of every sSMC and in special cases to describe and predict the possible clinical phenotype.Τα μικρά υπεράριθμα χρωμοσώματα-δείκτες (sSMCs) ορίζονται ως δομικές χρωμοσωμικές ανωμαλίες, μεγέθους ίσου ή μικρότερου από το χρωμόσωμα 20 που δεν μπορούν να χαρακτηρισθούν και να ταυτοποιηθούν με τις κλασικές κυτταρογενετικές τεχνικές. Ένα sSMC μπορεί να εμφανίζεται σε καρυότυπο με (1) 46 φυσιολογικά χρωμοσώματα, (2) αριθμητικές ανωμαλίες (π.χ. Turner syndrome ή Down syndrome), ή (3) δομικές ισοζυγισμένες ανωμαλίες. Τα sSMCs εμφανίζονται με συχνότητα 0.075% σε μη επιλεγμένα περιστατικά προγεννητικού ελέγχου ενώ μόνο 0.044% σε μεταγεννητικά περιστατικά. Η συχνότητα των sSMC στα περιστατικά προγεννητικού ελέγχου με υπερηχογραφικές ανωμαλίες είναι τουλάχιστον πέντε φορές μεγαλύτερη από ότι στα νεογνά και τουλάχιστον τρεις φορές υψηλότερη από ότι στα μη επιλεγμένα προγεννητικά περιστατικά. Επίσης 0.288% των ασθενών με αναπτυξιακή/νοητική υστέρηση έχουν ένα sSMC. Περίπου το 70% των de novo sSMC δεν έχει φαινοτυπικές επιπτώσεις. Ο κίνδυνος για φαινοτυπικές ανωμαλίες σε περιπτώσεις προγεννητικής εντόπισης ανέρχεται περίπου στο 13%. Αυτό εξαρτάται τόσο από την προέλευση του χρωμοσώματος-δείκτη, όσο και από το εάν εμφανίζεται για πρώτη φορά στο έμβρυο (de novo), ή είναι οικογενής (familial). Ο κίνδυνος μπορεί να κυμαίνεται από 7% όταν το de novo sSMCs προέρχεται από τα χρωμοσώματα 13, 14, 15, 21 και 22, έως το 28% για τα μη ακροκεντρικά χρωμοσώματα. Επίσης, περισσότερα από 98% των κληρονομούμενων sSMC είναι χωρίς φαινοτυπικές επιπτώσεις. Στον προγεννητικό έλεγχο το 16% των sSMC έχει κλινικές επιπτώσεις. Πιο συγκεκριμένα ο κίνδυνος για φαινοτυπικές ανωμαλίες ανέρχεται στο 10.9% για τα sSMC που προέρχονται από ακροκεντικά χρωμοσώματα και φθάνει στο 14% για τα μη ακροκεντρικά sSMC.Δεν γνωρίζουμε πάρα πολλά σχετικά με τον ακριβή τρόπο σχηματισμού των sSMC και είναι ιδιαίτερα ασαφές, πού, γιατί και πότε δημιουργείται ένα sSMC, κατά την διάρκεια της γαμετογένεσης ή της εμβρυογένεσης. Πάντως, υπάρχουν διάφορα μοντέλα του πώς δημιουργούνται οι διάφορες μορφές sSMC. Αυτές οι θεωρίες βασίζονται στα ευρήματα από το UPD και στην παρατήρηση ότι τα sSMCs μπορεί να δημιουργούνται από ατελή διόρθωση της τρισωμίας. Συνολικά, ένα sSMC σχηματίζεται από τον συνδυασμό δύο ή περισσοτέρων συμβάντων κατά της διάρκεια της γαμετογένεσης ή της εμβρυογένεσης.Κλασικά, η παρουσία ενός sSMC σε ένα ασθενή τεκμηριώνεται με την ζώνωση και ανάλυσή των χρωμοσωμάτων, είτε στο περιφερικό αίμα, είτε στο αμνιακό υγρό ή στις χοριακές λάχνες. Εάν με την κυτταρογενετική ανάλυση παρατηρηθεί ένα sSMC, τότε αυτό πρέπει να χαρακτηρισθεί περαιτέρω με μοριακές κυτταρογενετικές τεχνικές. Σήμερα με την ανάπτυξη της μοριακής κυτταρογενετικής και την χρήση των array-CGH μπορούν να χαρακτηριστούν σχεδόν όλες οι χρωμοσωμικές ανισοζυγίες.Ο σκοπός της παρούσας μελέτης ήταν να διερευνηθούν πλήρως τα sSMCs που εντοπίζονται σε δείγματα προγεννητικού ελέγχου, προκειμένου να δοθεί σωστή πρόγνωση και γενετική συμβουλευτική. Απώτερος στόχος της μελέτης ήταν να γίνει συσχέτιση του γονότυπου με το φαινότυπο, και ειδικότερα με τα υπερηχογραφικά ευρήματα αλλά και την κλινική εικόνα του νεογνού σε περιπτώσεις συνέχισης της κύησης. Συγκεκριμένα, η μελέτη εστιάστηκε στο χαρακτηρισμό και ταυτοποίηση των χρωμοσωμάτων δεικτών σε δείγματα προγεννητικού ελέγχου και συγχρόνως στη μελέτη της παρουσίας ή όχι ευχρωματικής περιοχής, εφαρμόζοντας τεχνικές κλασικής κυτταρογενετικής και τεχνικές μοριακής κυτταρογενετικής (φθορίζων in situ υβριδισμός, FISH και array-CGH).Παράλληλα μελετήθηκε η παρουσία ή όχι μονογονεϊκής δισωμίας (UPD), εστιάζοντας στα χρωμοσώματα δείκτες των οποίων η προέλευσή ήταν από χρωμοσώματα που εμπλέκονται σε μονογονεϊκή δισωμία. Για το σκοπό αυτό έγινε μοριακή ανάλυση για την ύπαρξη ή όχι μονογονεϊκής δισωμίας στα περιστατικά με υπεράριθμο μικρό χρωμόσωμα-δείκτη που έχουν αυξημένο κίνδυνο για UPD. Χαρακτηρίσθηκαν επιτυχώς 42 χρωμοσώματα δείκτες που εντοπίσθηκαν σε περίπου 50.000 προγεννητικά δείγματα αμνιακού υγρού και χοριακών λαχνών. Τα αποτελέσματα της παρούσας διδακτορικής διατριβής, ανέδειξαν τη συμβολή των μοριακών κυτταρογενετικών τεχνικών (FISH και array-CGH) στον ακριβή χαρακτηρισμό των μικρών χρωμοσωμάτων – δεικτών μετά τον εντοπισμό τους στον προγεννητικό έλεγχο. Χρησιμοποιώντας τεχνικές FISH και array-CGH στην παρούσα μελέτη κατορθώσαμε να χαρακτηρίσουμε επιτυχώς και τα 42 sSMCs που ανιχνεύθηκαν με την κλασσική κυτταρογενετική. Εκτός από την χρωμοσωμική προέλευση του sSMC προσδιορίσθηκε η παρουσία ή όχι ευχρωματίνης, το μέγεθος αυτής και ο αριθμός των γονιδίων που περιέχει. Συνολικά 19/42 (45%) περιπτώσεις από την συγκεκριμένη μελέτη συνδέονται με σημαντικά κλινικά ευρήματα. Αποτέλεσμα αυτών είναι να δοθούν σωστές γενετικές συμβουλές στα ζευγάρια.Στη παρούσα μελέτη εάν χρησιμοποιείτο μόνο η τεχνική array-CGH δεν θα είχαν ανιχνευθεί 16 περιπτώσεις sSMCs που αποτελούντο αποκλειστικά από ετεροχρωματικό υλικό. Στις 12/16 περιπτώσεις τo sSMC προέρχονταν από χρωμοσώματα όπως το 14 ή το 15 που ήταν απαραίτητη η ανάλυση UPD. Αντίθετα η μη χρησιμοποίηση των array-CGH δεν θα αποκάλυπτε την πολυπλοκότητα κάποιων sSMCs ούτε τον λεπτομερή χαρακτηρισμό αυτών των sSMCs, με αποτέλεσμα να μην υπάρχει σαφής εικόνα για την πρόγνωση και την γενετική συμβουλευτική. Η εκτεταμένη εφαρμογή του array-CGH αποκαλύπτει περισσότερες εκπλήξεις και πιθανόν να διαφοροποιηθεί η άποψη σχετικά με τη σύνθεση των υπεράριθμων χρωμοσωμάτων δείκτων. Συμπερασματικά η μοριακή κυτταρογενετική (FISH, array-CGH) σε συνδυασμό με άλλες μοριακές τεχνικές (UPD) μπορεί να παράσχει πολύτιμες πληροφορίες σχετικά με την χρωμοσωμική προέλευση και τη σύνθεση των χρωμοσωμάτων δεικτών στην προγεννητική διάγνωση. Με τη νέα τεχνολογία array-CGH είναι δυνατό να χαρακτηριστεί πλήρως το γενετικό περιεχόμενο του κάθε δείκτη και, σε ειδικές περιπτώσεις, να περιγραφεί και να προβλεφθεί ο πιθανός κλινικός φαινότυπος

Routine use of array comparative genomic hybridization (aCGH) as standard approach for prenatal diagnosis of chromosomal abnormalities. Clinical experience of 1763 prenatal cases

Objective: This study aims to evaluate the diagnostic yield of comparative genomic hybridization microarrays (aCGH) and compare it with conventional karyotype analysis of standard >5-Mb resolution. Method: A total of 1763 prenatal samples were analyzed by aCGH (CytoChip Focus Constitutional microarrays, BlueGnome, Cambridge). The diagnostic yield of chromosomal abnormalities detected by aCGH was assessed, compared with conventional karyotype analysis. Results: The result was pathogenic/unknown penetrance in 125 cases (7.1%), and a variant of unknown significance (VOUS) was detected in 13 cases (0.7%). Out of the 125 cases with abnormal findings, 110 were also detected by conventional karyotype analysis. The aCGH increment in diagnostic yield was 0.9% (15/1763) and 1.6% when VOUS were included. Stratifying the sample according to indications for prenatal invasive testing, the highest values of diagnostic yield increment were observed for patients positive for second-trimester sonographic markers (1.5%) and for the presence of fetal structural anomalies (1.3%). In contrast, the incremental yield was marginal in patients with fetus with increased nuchal translucency (0.5%). Conclusion: The present study indicates that routine implementation of aCGH offers an incremental yield over conventional karyotype analysis, which is also present in cases with 'milder' indications, further supporting its use as a first-tier test. What's already known about this topic? Array CGH has an incremental yield over conventional cytogenetics, which has been mostly highlighted in cases of fetuses with structural defects. What does this study add? The present study is one of the few large cohort studies that support the use of aCGH as a first-tier test for prenatal diagnosis of chromosomal abnormalities, with a significant increase of the incremental diagnostic yield of chromosomal abnormalities. Apart from fetuses with structural defects, an incremental diagnostic yield was also observed for cases with milder indications for invasive testing, for example, second-trimester markers or advanced maternal age, supporting the preferable use of more comprehensive diagnostic approaches in prenatal testing of chromosomal abnormalities

Autism spectrum disorder, anxiety and severe depression in a male patient with deletion and duplication in the 21q22.3 region: A case report

In this report, a patient carrying a 650 kb deletion and a 759 kb duplication of chromosomal 21q22.3 region was described. Facial dysmorphic features, hypotonia, short stature, learning impairment, autism spectrum disorder, anxiety and depression were observed clinical characteristics. Mentioned copy number variants were the shortest in length reported so far. The current study hypothesized that the presence of a susceptibility locus for autism spectrum disorder associated with depression and anxiety may be located in a 200 kb region between the PCNT and PRMT2 genes. The current study aimed to provide insight into the human genome morbidity map of chromosome 21