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Design and Implementation of the International Genetics and Translational Research in Transplantation Network
Keating, Brendan J; van Setten, Jessica; Jacobson, Pamala A; Holmes, Michael V; Verma, Shefali S; Chandrupatla, Hareesh R; Nair, Nikhil; Gao, Hui; Li, Yun R; Chang, Bao-Li; Wong, Chanel; Phillips, Randy; Cole, Brian S; Mukhtar, Eyas; Zhang, Weijia; Cao, Hongzhi; Mohebnasab, Maede; Hou, Cuiping; Lee, Takesha; Steel, Laura; Shaked, Oren; Garifallou, James; Miller, Michael B; Karczewski, Konrad J; Akdere, Abdullah; Gonzalez, Ana; Lloyd, Kelsey M; McGinn, Daniel; Michaud, Zach; Colasacco, Abigail; Lek, Monkol; Fu, Yao; Pawashe, Mayur; Guettouche, Toumy; Himes, Aubree; Perez, Leat; Guan, Weihua; Wu, Baolin; Schladt, David; Menon, Madhav; Zhang, Zhongyang; Tragante, Vinicius; de Jonge, Nicolaas; Otten, Henny G; de Weger, Roel A; van de Graaf, Ed A; Baan, Carla C; Manintveld, Olivier C; De Vlaminck, Iwijn; Piening, Brian D; Strehl, Calvin; Shaw, Mary; Snieder, Harold; Klintmalm, Goran B; O'Leary, Jacqueline G; Amaral, Sandra; Goldfarb, Samuel; Rand, Elizabeth; Rossano, Joseph W; Kohli, Utkarsh; Heeger, Peter; Stahl, Eli; Christie, Jason D; Fuentes, Maria Hernandez; Levine, John E; Aplenc, Richard; Schadt, Eric E; Stranger, Barbara E; Kluin, Jolanda; Potena, Luciano; Zuckermann, Andreas; Khush, Kiran; Alzahrani, Alhusain J; Al-Muhanna, Fahad A; Al-Ali, Amein K; Al-Ali, Rudaynah; Al-Rubaish, Abdullah M; Al-Mueilo, Samir; Byrne, Edna M; Miller, David; Alexander, Stephen I; Onengut-Gumuscu, Suna; Rich, Stephen S; Suthanthiran, Manikkam; Tedesco, Helio; Saw, Chee L; Ragoussis, Jiannis; Kfoury, Abdallah G; Horne, Benjamin; Carlquist, John; Gerstein, Mark B; Reindl-Schwaighofer, Roman; Oberbauer, Rainer; Wijmenga, Cisca; Palmer, Scott; Pereira, Alexandre C; Segovia, Javier; Alonso-Pulpon, Luis A; Comez-Bueno, Manuel; Vilches, Carlos; Jaramillo, Natalia; de Borst, Martin H; Naesens, Maarten; Hao, Ke; MacArthur, Daniel G; Balasubramanian, Suganthi; Conlon, Peter J; Lord, Graham M; Ritchie, Marylyn D; Snyder, Michael; Olthoff, Kim M; Moore, Jason H; Petersdorf, Effie W; Kamoun, Malek; Wang, Jun; Monos, Dimitri S; de Bakker, Paul I W; Hakonarson, Hakon; Murphy, Barbara; Lankree, Matthew B; Garcia-Pavia, Pablo; Oetting, William S; Birdwell, Kelly A; Bakker, Stephan J L; Israni, Ajay K; Shaked, Abraham; Asselbergs, Folkert W
BACKGROUND:Genetic association studies of transplantation outcomes have been hampered by small samples and highly complex multifactorial phenotypes, hindering investigations of the genetic architecture of a range of comorbidities which significantly impact graft and recipient life expectancy. We describe here the rationale and design of the International Genetics & Translational Research in Transplantation Network. The network comprises 22 studies to date, including 16494 transplant recipients and 11669 donors, of whom more than 5000 are of non-European ancestry, all of whom have existing genomewide genotype data sets. METHODS:We describe the rich genetic and phenotypic information available in this consortium comprising heart, kidney, liver, and lung transplant cohorts. RESULTS:We demonstrate significant power in International Genetics & Translational Research in Transplantation Network to detect main effect association signals across regions such as the MHC region as well as genomewide for transplant outcomes that span all solid organs, such as graft survival, acute rejection, new onset of diabetes after transplantation, and for delayed graft function in kidney only. CONCLUSIONS:This consortium is designed and statistically powered to deliver pioneering insights into the genetic architecture of transplant-related outcomes across a range of different solid-organ transplant studies. The study design allows a spectrum of analyses to be performed including recipient-only analyses, donor-recipient HLA mismatches with focus on loss-of-function variants and nonsynonymous single nucleotide polymorphisms.
PMCID:4623847
PMID: 26479416
ISSN: 1534-6080
CID: 5479282
Genetic sharing and heritability of paediatric age of onset autoimmune diseases
Li, Yun R; Zhao, Sihai D; Li, Jin; Bradfield, Jonathan P; Mohebnasab, Maede; Steel, Laura; Kobie, Julie; Abrams, Debra J; Mentch, Frank D; Glessner, Joseph T; Guo, Yiran; Wei, Zhi; Connolly, John J; Cardinale, Christopher J; Bakay, Marina; Li, Dong; Maggadottir, S Melkorka; Thomas, Kelly A; Qui, Haijun; Chiavacci, Rosetta M; Kim, Cecilia E; Wang, Fengxiang; Snyder, James; Flato, Berit; Forre, Oystein; Denson, Lee A; Thompson, Susan D; Becker, Mara L; Guthery, Stephen L; Latiano, Anna; Perez, Elena; Resnick, Elena; Strisciuglio, Caterina; Staiano, Annamaria; Miele, Erasmo; Silverberg, Mark S; Lie, Benedicte A; Punaro, Marilynn; Russell, Richard K; Wilson, David C; Dubinsky, Marla C; Monos, Dimitri S; Annese, Vito; Munro, Jane E; Wise, Carol; Chapel, Helen; Cunningham-Rundles, Charlotte; Orange, Jordan S; Behrens, Edward M; Sullivan, Kathleen E; Kugathasan, Subra; Griffiths, Anne M; Satsangi, Jack; Grant, Struan F A; Sleiman, Patrick M A; Finkel, Terri H; Polychronakos, Constantin; Baldassano, Robert N; Luning Prak, Eline T; Ellis, Justine A; Li, Hongzhe; Keating, Brendan J; Hakonarson, Hakon
Autoimmune diseases (AIDs) are polygenic diseases affecting 7-10% of the population in the Western Hemisphere with few effective therapies. Here, we quantify the heritability of paediatric AIDs (pAIDs), including JIA, SLE, CEL, T1D, UC, CD, PS, SPA and CVID, attributable to common genomic variations (SNP-h(2)). SNP-h(2) estimates are most significant for T1D (0.863+/-s.e. 0.07) and JIA (0.727+/-s.e. 0.037), more modest for UC (0.386+/-s.e. 0.04) and CD (0.454+/-0.025), largely consistent with population estimates and are generally greater than that previously reported by adult GWAS. On pairwise analysis, we observed that the diseases UC-CD (0.69+/-s.e. 0.07) and JIA-CVID (0.343+/-s.e. 0.13) are the most strongly correlated. Variations across the MHC strongly contribute to SNP-h(2) in T1D and JIA, but does not significantly contribute to the pairwise rG. Together, our results partition contributions of shared versus disease-specific genomic variations to pAID heritability, identifying pAIDs with unexpected risk sharing, while recapitulating known associations between autoimmune diseases previously reported in adult cohorts.
PMCID:4633631
PMID: 26450413
ISSN: 2041-1723
CID: 1808672
Concept and design of a genome-wide association genotyping array tailored for transplantation-specific studies
Li, Yun R; van Setten, Jessica; Verma, Shefali S; Lu, Yontao; Holmes, Michael V; Gao, Hui; Lek, Monkol; Nair, Nikhil; Chandrupatla, Hareesh; Chang, Baoli; Karczewski, Konrad J; Wong, Chanel; Mohebnasab, Maede; Mukhtar, Eyas; Phillips, Randy; Tragante, Vinicius; Hou, Cuiping; Steel, Laura; Lee, Takesha; Garifallou, James; Guettouche, Toumy; Cao, Hongzhi; Guan, Weihua; Himes, Aubree; van Houten, Jacob; Pasquier, Andrew; Yu, Reina; Carrigan, Elena; Miller, Michael B; Schladt, David; Akdere, Abdullah; Gonzalez, Ana; Llyod, Kelsey M; McGinn, Daniel; Gangasani, Abhinav; Michaud, Zach; Colasacco, Abigail; Snyder, James; Thomas, Kelly; Wang, Tiancheng; Wu, Baolin; Alzahrani, Alhusain J; Al-Ali, Amein K; Al-Muhanna, Fahad A; Al-Rubaish, Abdullah M; Al-Mueilo, Samir; Monos, Dimitri S; Murphy, Barbara; Olthoff, Kim M; Wijmenga, Cisca; Webster, Teresa; Kamoun, Malek; Balasubramanian, Suganthi; Lanktree, Matthew B; Oetting, William S; Garcia-Pavia, Pablo; MacArthur, Daniel G; de Bakker, Paul I W; Hakonarson, Hakon; Birdwell, Kelly A; Jacobson, Pamala A; Ritchie, Marylyn D; Asselbergs, Folkert W; Israni, Ajay K; Shaked, Abraham; Keating, Brendan J
BACKGROUND:In addition to HLA genetic incompatibility, non-HLA difference between donor and recipients of transplantation leading to allograft rejection are now becoming evident. We aimed to create a unique genome-wide platform to facilitate genomic research studies in transplant-related studies. We designed a genome-wide genotyping tool based on the most recent human genomic reference datasets, and included customization for known and potentially relevant metabolic and pharmacological loci relevant to transplantation. METHODS:We describe here the design and implementation of a customized genome-wide genotyping array, the 'TxArray', comprising approximately 782,000 markers with tailored content for deeper capture of variants across HLA, KIR, pharmacogenomic, and metabolic loci important in transplantation. To test concordance and genotyping quality, we genotyped 85 HapMap samples on the array, including eight trios. RESULTS:We show low Mendelian error rates and high concordance rates for HapMap samples (average parent-parent-child heritability of 0.997, and concordance of 0.996). We performed genotype imputation across autosomal regions, masking directly genotyped SNPs to assess imputation accuracy and report an accuracy of >0.962 for directly genotyped SNPs. We demonstrate much higher capture of the natural killer cell immunoglobulin-like receptor (KIR) region versus comparable platforms. Overall, we show that the genotyping quality and coverage of the TxArray is very high when compared to reference samples and to other genome-wide genotyping platforms. CONCLUSIONS:We have designed a comprehensive genome-wide genotyping tool which enables accurate association testing and imputation of ungenotyped SNPs, facilitating powerful and cost-effective large-scale genotyping of transplant-related studies.
PMCID:4589899
PMID: 26423053
ISSN: 1756-994x
CID: 5478362
Meta-analysis of shared genetic architecture across ten pediatric autoimmune diseases
Li, Yun R; Li, Jin; Zhao, Sihai D; Bradfield, Jonathan P; Mentch, Frank D; Maggadottir, S Melkorka; Hou, Cuiping; Abrams, Debra J; Chang, Diana; Gao, Feng; Guo, Yiran; Wei, Zhi; Connolly, John J; Cardinale, Christopher J; Bakay, Marina; Glessner, Joseph T; Li, Dong; Kao, Charlly; Thomas, Kelly A; Qiu, Haijun; Chiavacci, Rosetta M; Kim, Cecilia E; Wang, Fengxiang; Snyder, James; Richie, Marylyn D; Flato, Berit; Forre, Oystein; Denson, Lee A; Thompson, Susan D; Becker, Mara L; Guthery, Stephen L; Latiano, Anna; Perez, Elena; Resnick, Elena; Russell, Richard K; Wilson, David C; Silverberg, Mark S; Annese, Vito; Lie, Benedicte A; Punaro, Marilynn; Dubinsky, Marla C; Monos, Dimitri S; Strisciuglio, Caterina; Staiano, Annamaria; Miele, Erasmo; Kugathasan, Subra; Ellis, Justine A; Munro, Jane E; Sullivan, Kathleen E; Wise, Carol A; Chapel, Helen; Cunningham-Rundles, Charlotte; Grant, Struan F A; Orange, Jordan S; Sleiman, Patrick M A; Behrens, Edward M; Griffiths, Anne M; Satsangi, Jack; Finkel, Terri H; Keinan, Alon; Prak, Eline T Luning; Polychronakos, Constantin; Baldassano, Robert N; Li, Hongzhe; Keating, Brendan J; Hakonarson, Hakon
Genome-wide association studies (GWASs) have identified hundreds of susceptibility genes, including shared associations across clinically distinct autoimmune diseases. We performed an inverse chi(2) meta-analysis across ten pediatric-age-of-onset autoimmune diseases (pAIDs) in a case-control study including more than 6,035 cases and 10,718 shared population-based controls. We identified 27 genome-wide significant loci associated with one or more pAIDs, mapping to in silico-replicated autoimmune-associated genes (including IL2RA) and new candidate loci with established immunoregulatory functions such as ADGRL2, TENM3, ANKRD30A, ADCY7 and CD40LG. The pAID-associated single-nucleotide polymorphisms (SNPs) were functionally enriched for deoxyribonuclease (DNase)-hypersensitivity sites, expression quantitative trait loci (eQTLs), microRNA (miRNA)-binding sites and coding variants. We also identified biologically correlated, pAID-associated candidate gene sets on the basis of immune cell expression profiling and found evidence of genetic sharing. Network and protein-interaction analyses demonstrated converging roles for the signaling pathways of type 1, 2 and 17 helper T cells (TH1, TH2 and TH17), JAK-STAT, interferon and interleukin in multiple autoimmune diseases.
PMCID:4863040
PMID: 26301688
ISSN: 1546-170x
CID: 1809002
Genetic meta-analysis of 15,901 African Americans identifies variation in EXOC3L1 is associated with HDL concentration
Lanktree, Matthew B; Elbers, Clara C; Li, Yun; Zhang, Guosheng; Duan, Qing; Karczewski, Konrad J; Guo, Yiran; Tragante, Vinicius; North, Kari E; Cushman, Mary; Asselbergs, Folkert W; Wilson, James G; Lange, Leslie A; Drenos, Fotios; Reiner, Alex P; Barnes, Michael R; Keating, Brendan J
Meta-analyses of European populations has successfully identified genetic variants in over 150 loci associated with lipid levels, but results from additional ethnicities remain limited. Previously, we reported two novel lipid loci identified in a sample of 7,657 African Americans using a gene-centric array including 50,000 SNPs in 2,100 candidate genes. Initial discovery and follow-up of signals with P < 10(-5) in additional African American samples confirmed CD36 and ICAM1. Using an additional 8,244 African American female samples from the Women's Health Initiative SNP Health Association Resource genome-wide association study dataset, we further examined the previous meta-analyses results by attempting to replicate 20 additional putative lipid signals with P < 10(-4). Replication confirmed rs868213, located in a splice donor region of exocyst complex component 3-like 1 (EXOC3L1) as a novel signal for HDL (additive allelic effect β = 0.02; P = 1.4 × 10(-8); meta-analyses of discovery and replication). EXOC3L1 is strongly expressed in vascular endothelium and forms part of the exocyst complex, a key facilitator of the trafficking of lipid receptors. Increasing sample sizes for genetic studies in nonEuropean populations will continue to improve our understanding of lipid metabolism.
PMCID:4548782
PMID: 26199122
ISSN: 1539-7262
CID: 5478352
Genetic Predisposition to Dyslipidemia and Risk of Preeclampsia
Spracklen, Cassandra N; Saftlas, Audrey F; Triche, Elizabeth W; Bjonnes, Andrew; Keating, Brendan; Saxena, Richa; Breheny, Patrick J; Dewan, Andrew T; Robinson, Jennifer G; Hoh, Josephine; Ryckman, Kelli K
BACKGROUND:Large epidemiologic studies support the role of dyslipidemia in preeclampsia; however, the etiology of preeclampsia or whether dyslipidemia plays a causal role remains unclear. We examined the association between the genetic predisposition to dyslipidemia and risk of preeclampsia using validated genetic markers of dyslipidemia. METHODS:Preeclampsia cases (n = 164) and normotensive controls (n = 110) were selected from live birth certificates to nulliparous Iowa women during the period August 2002 to May 2005. Disease status was verified by medical chart review. Genetic predisposition to dyslipidemia was estimated by 4 genetic risk scores (GRS) (total cholesterol (TC), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C), and triglycerides) on the basis of established loci for blood lipids. Logistic regression analyses were used to evaluate the relationships between each of the 4 genotype scores and preeclampsia. Replication analyses were performed in an independent, US population of preeclampsia cases (n = 516) and controls (n = 1,097) of European ancestry. RESULTS:The GRS related to higher levels of TC, LDL-C, and triglycerides demonstrated no association with the risk of preeclampsia in either the Iowa or replication population. The GRS related to lower HDL-C was marginally associated with an increased risk for preeclampsia (odds ratio (OR) = 1.03, 95% confidence interval (CI) = 0.99-1.07; P = 0.10). In the independent replication population, the association with the HDL-C GRS was also marginally significant (OR = 1.03, 95% CI: 1.00-1.06; P = 0.04). CONCLUSIONS:Our data suggest a potential effect between the genetic predisposition to dyslipidemic levels of HDL-C and an increased risk of preeclampsia, and, as such, suggest that dyslipidemia may be a component along the causal pathway to preeclampsia.
PMCID:4542907
PMID: 25523295
ISSN: 1941-7225
CID: 5478242
Gene-centric approach identifies new and known loci for FVIII activity and VWF antigen levels in European Americans and African Americans
Tang, Weihong; Cushman, Mary; Green, David; Rich, Stephen S; Lange, Leslie A; Yang, Qiong; Tracy, Russell P; Tofler, Geoffrey H; Basu, Saonli; Wilson, James G; Keating, Brendan J; Weng, Lu-Chen; Taylor, Herman A; Jacobs, David R; Delaney, Joseph A; Palmer, Cameron D; Young, Taylor; Pankow, James S; O'Donnell, Christopher J; Smith, Nicholas L; Reiner, Alexander P; Folsom, Aaron R
Coagulation factor VIII and von Willebrand factor (VWF) are key proteins in procoagulant activation. Higher FVIII coagulant activity (FVIII :C) and VWF antigen (VWF :Ag) are risk factors for cardiovascular disease and venous thromboembolism. Beyond associations with ABO blood group, genetic determinants of FVIII and VWF are not well understood, especially in non European-American populations. We performed a genetic association study of FVIII :C and VWF:Ag that assessed 50,000 gene-centric single nucleotide polymorphisms (SNPs) in 18,556 European Americans (EAs) and 5,047 African Americans (AAs) from five population-based cohorts. Previously unreported associations for FVIII :C were identified in both AAs and EAs with KNG1 (most significantly associated SNP rs710446, Ile581Thr, Ile581Thr, P = 5.10 × 10(-7) in EAs and P = 3.88 × 10(-3) in AAs) and VWF rs7962217 (Gly2705Arg,P = 6.30 × 10(-9) in EAs and P = 2.98 × 10(-2) in AAs. Significant associations for FVIII :C were also observed with F8/TMLHE region SNP rs12557310 in EAs (P = 8.02 × 10(-10) ), with VWF rs1800380 in AAs (P = 5.62 × 10(-11) ), and with MAT1A rs2236568 in AAs (P51.69 × 10(-6) ). We replicated previously reported associations of FVIII :C and VWF :Ag with the ABO blood group, VWF rs1063856(Thr789Ala), rs216321 (Ala852Gln), and VWF rs2229446 (Arg2185Gln). Findings from this study expand our understanding of genetic influences for FVIII :C and VWF :Ag in both EAs and AAs.
PMCID:4747096
PMID: 25779970
ISSN: 1096-8652
CID: 5478292
Advances in risk prediction of type 2 diabetes: integrating genetic scores with Framingham risk models [Comment]
Keating, Brendan J
PMID: 25908872
ISSN: 1939-327x
CID: 5478302
Mutation in mitochondrial ribosomal protein S7 (MRPS7) causes congenital sensorineural deafness, progressive hepatic and renal failure and lactic acidemia
Menezes, Minal J; Guo, Yiran; Zhang, Jianguo; Riley, Lisa G; Cooper, Sandra T; Thorburn, David R; Li, Jiankang; Dong, Daoyuan; Li, Zhijun; Glessner, Joseph; Davis, Ryan L; Sue, Carolyn M; Alexander, Stephen I; Arbuckle, Susan; Kirwan, Paul; Keating, Brendan J; Xu, Xun; Hakonarson, Hakon; Christodoulou, John
Functional defects of the mitochondrial translation machinery, as a result of mutations in nuclear-encoded genes, have been associated with combined oxidative phosphorylation (OXPHOS) deficiencies. We report siblings with congenital sensorineural deafness and lactic acidemia in association with combined respiratory chain (RC) deficiencies of complexes I, III and IV observed in fibroblasts and liver. One of the siblings had a more severe phenotype showing progressive hepatic and renal failure. Whole-exome sequencing revealed a homozygous mutation in the gene encoding mitochondrial ribosomal protein S7 (MRPS7), a c.550A>G transition that encodes a substitution of valine for a highly conserved methionine (p.Met184Val) in both affected siblings. MRPS7 is a 12S ribosomal RNA-binding subunit of the small mitochondrial ribosomal subunit, and is required for the assembly of the small ribosomal subunit. Pulse labeling of mitochondrial protein synthesis products revealed impaired mitochondrial protein synthesis in patient fibroblasts. Exogenous expression of wild-type MRPS7 in patient fibroblasts rescued complexes I and IV activities, demonstrating the deleterious effect of the mutation on RC function. Moreover, reduced 12S rRNA transcript levels observed in the patient's fibroblasts were also restored to normal levels by exogenous expression of wild-type MRPS7. Our data demonstrate the pathogenicity of the identified MRPS7 mutation as a novel cause of mitochondrial RC dysfunction, congenital sensorineural deafness and progressive hepatic and renal failure.
PMID: 25556185
ISSN: 1460-2083
CID: 5478262
De novo heterozygous mutations in SMC3 cause a range of Cornelia de Lange syndrome-overlapping phenotypes
Gil-Rodríguez, María Concepción; Deardorff, Matthew A; Ansari, Morad; Tan, Christopher A; Parenti, Ilaria; Baquero-Montoya, Carolina; Ousager, Lilian B; Puisac, Beatriz; Hernández-Marcos, María; Teresa-Rodrigo, María Esperanza; Marcos-Alcalde, Iñigo; Wesselink, Jan-Jaap; Lusa-Bernal, Silvia; Bijlsma, Emilia K; Braunholz, Diana; Bueno-Martinez, Inés; Clark, Dinah; Cooper, Nicola S; Curry, Cynthia J; Fisher, Richard; Fryer, Alan; Ganesh, Jaya; Gervasini, Cristina; Gillessen-Kaesbach, Gabriele; Guo, Yiran; Hakonarson, Hakon; Hopkin, Robert J; Kaur, Maninder; Keating, Brendan J; Kibaek, María; Kinning, Esther; Kleefstra, Tjitske; Kline, Antonie D; Kuchinskaya, Ekaterina; Larizza, Lidia; Li, Yun R; Liu, Xuanzhu; Mariani, Milena; Picker, Jonathan D; Pié, Ángeles; Pozojevic, Jelena; Queralt, Ethel; Richer, Julie; Roeder, Elizabeth; Sinha, Anubha; Scott, Richard H; So, Joyce; Wusik, Katherine A; Wilson, Louise; Zhang, Jianguo; Gómez-Puertas, Paulino; Casale, César H; Ström, Lena; Selicorni, Angelo; Ramos, Feliciano J; Jackson, Laird G; Krantz, Ian D; Das, Soma; Hennekam, Raoul C M; Kaiser, Frank J; FitzPatrick, David R; Pié, Juan
Cornelia de Lange syndrome (CdLS) is characterized by facial dysmorphism, growth failure, intellectual disability, limb malformations, and multiple organ involvement. Mutations in five genes, encoding subunits of the cohesin complex (SMC1A, SMC3, RAD21) and its regulators (NIPBL, HDAC8), account for at least 70% of patients with CdLS or CdLS-like phenotypes. To date, only the clinical features from a single CdLS patient with SMC3 mutation has been published. Here, we report the efforts of an international research and clinical collaboration to provide clinical comparison of 16 patients with CdLS-like features caused by mutations in SMC3. Modeling of the mutation effects on protein structure suggests a dominant-negative effect on the multimeric cohesin complex. When compared with typical CdLS, many SMC3-associated phenotypes are also characterized by postnatal microcephaly but with a less distinctive craniofacial appearance, a milder prenatal growth retardation that worsens in childhood, few congenital heart defects, and an absence of limb deficiencies. While most mutations are unique, two unrelated affected individuals shared the same mutation but presented with different phenotypes. This work confirms that de novo SMC3 mutations account for ∼ 1%-2% of CdLS-like phenotypes.
PMID: 25655089
ISSN: 1098-1004
CID: 5478282