Identification of a Novel Homozygous Nonsense Mutation in a Fetus with Bardet-Biedl Syndrome

doi:10.21203/rs.3.rs-967831/v1

Download PDF

Research Article

Identification of a Novel Homozygous Nonsense Mutation in a Fetus with Bardet-Biedl Syndrome

https://doi.org/10.21203/rs.3.rs-967831/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Background: Bardet-Biedl syndrome (BBS) is a rare autosomal recessive genetic disorder with clinical and genetic heterogeneity. BBS is more commonly reported in adults and children than in fetuses. Here, we reported the intrauterine phenotype and molecular characterizations of a fetus with BBS.

Methods: Chromosome karyotype analysis, whole exome sequencing (WES), and a single nucleotide polymorphism array (SNP-array) were used to analyze the genetic etiology of a fetus with enlarged kidneys, enhanced echo, and oligohydramnios.

Results: The results of chromosome karyotype analysis and SNP-array on the fetus were normal. WES, however, revealed homozygous mutation of c.1177C>T (p.Arg393*) on exon 12 of the BBS1 gene, and heterozygous variation of c.2704G>A (p.Asp902Asn) on exon 22 of the CC2D2A gene. According to ACMG guidelines, c.1177C> T was identified as a pathogenic mutation and c.2704G>A was identified as an uncertain significance. Sanger sequencing showed that there was heterozygous mutation of c.1177C>T and heterozygous variation of c.2704G>A in the parents of the fetus.

Conclusions: WES identified a novel homozygous nonsense mutation c.1177C>T in the BBS1 gene of a Chinese fetus. The finding provides more insight into BBS1 mutations in Asian populations in general, and provides a basis for genetic counseling.

General Biochemistry

Molecular Biology

Bardet-Biedl syndrome

rare autosomal recessive genetic disorder

whole exome sequencing

Bardet-Biedl syndrome (BBS) (MIM 209900) is a rare autosomal recessive genetic disorder. The prevalence of BBS in European and North American populations is about 1/160,000-1/140,000 [1], and the incidence in Asian populations is even lower, at about 1 in 18 million [2]. Its main characteristics are mental retardation, retinopathy pigmentosa, polydactyly (toe), obesity, gonadal hypoplasia, renal dysplasia, and short stature [3, 4]. Secondary clinical manifestations include developmental retardation, motor and neurological dysfunction, speech disorders, and behavioral abnormalities, as well as eye cataracts, strabismus, and astigmatism.

So far, a total of 21 genes that cause BBS phenotypes have been identified [5, 6]. Different BBS-related genes lead to different morbidities. For example, reports showed that BBS related to BBS1 [7], BBS2 [8], BBS6 [9], BBS9 [10], BBS10 [11], and BBS12 [12] gene mutations accounted for 23.3%, 8.1%, 5.8%, 6.0%, 20%, and 5%, respectively [13]. The mutation type frequencies of different BBS genes were different in different ethnic groups. BBS1 was found to have a high mutation frequency in European populations, leading to the occurrence of BBS, while BBS7 gene mutation was more commonly found in the Chinese population. Although current studies have found that mutations in 21 BBS genes can result in BBS phenotypes, only 80% of patients have mutations located in these genes, and about 20% of BBS instances are unrelated to them. This suggests that there are still discoveries to be made about some BBS-related genes, necessitating further study. Several challenges still exist regarding the genetic diagnosis and treatment of this disease.

BBS is a relatively rare condition. Because it heavily damages multiple systems and organs, it results in a very high disability rate. At present, our understanding of the pathogenic molecular mechanism of BBS is still not complete, and there are no special treatments targeting this condition [14]. Therefore, avoiding consanguineous marriage and using effective prenatal screening are still important preventive measures for BBS [15, 16].

To our knowledge, no instances of BBS associated with BBS1 variants have been reported in the Chinese population. We retrospectively analyzed a fetus diagnosed with BBS1 mutation in an Asian population and analyzed their pedigrees to explore the relationship between intrauterine phenotypes and fetal genotypes. This was done with the ultimate goal of improving our diagnostic and monitoring methods, as well as our understanding of the disease overall.

Study participants

The 25-year-old pregnant mother had a normal phenotype and was of average intelligence. She had no prior children, but had one miscarriage. No significant family history was found. At 24⁺² weeks of gestation, an ultrasound showed that both kidneys were enlarged and echo was enhanced, resulting in what was suspected to be infantile polycystic kidney disease. At the same time, the amniotic fluid index was 2.9 cm, which was slightly low (Figure 1).

Chromosome karyotype analysis

Transabdominal amniocentesis was performed under the guidance of ultrasound, and 40 ml of amniotic fluid was extracted. A volume of 20 ml was cultured in vitro under aseptic conditions, and another 20 ml was used for DNA extraction. The cultured amniotic fluid cells were harvested, fixed, and prepared for karyotyping and G banding. Chromosomal abnormalities were described according to the International System of Human Cytogenetics Nomenclature (2016).

Single nucleotide polymorphism array (SNP-array)

The experiment was conducted in strict accordance with standard operating procedures provided by Affymetrix, including DNA extraction, preparation, digestion and ligation, as well as amplification, purification, and fragmentation. DNA labeling, hybridization, washing, staining, and scanning were conducted according to those same procedures as well. The data were analyzed using a kit supported by CHAS 2.0 software. Then, the SNP array structure was analyzed, in combination with the relevant databases, to determine the nature of the copy number variation (CNV) found. These reference databases included DGV (http://dgv.tcag.ca/dgv/app/home), DECIPHER (http://decipher.sanger.ac.uk/), OMIM (http://www.omim.org), ISCA (http://www.iscaconsortium.org), and CAGdb (http://www.cagdb.org/), among others. CNVs can be divided into five categories [17, 18]: pathogenic, possibly pathogenic, of uncertain clinical significance (VUS), possibly benign, and benign. For the VUS, it is recommended to conduct SNP-array testing in on fetal cells isolated from maternal peripheral blood to further clarify the nature of CNV, in combination with pedigree analysis.

Whole exome sequencing (WES)

The fetal DNA was interrupted, and a library was prepared. Then, the exon of the target gene, and DNA in the adjacent shear region, were captured and enriched via Roche KAPA HyperExome chip. Finally, the mutation was detected using the MGISEQ-2000 sequencing platform. The quality control index of sequencing data was as follows: the average sequencing depth of the target region was ≥ 180X, and loci with average depths of > 20X in the target region accounted for over 95% of total loci. Sequenced fragments were compared with the UCSC hg19 human reference genome to remove duplicates. INDEL and genotype detection were performed using GATK. ExomeDepth was used for copy number variation detection at the exon level, and genes were named according to the Human Genome Organization Gene Nomenclature Committee (HGNC). Variants were named according to Human Genome Variation Society (HGVS) nomenclature. The reference database and prediction software versions were below: Clinvar (2020-03-16), ESP6500 (V2), and 1000 Genomes (Phase3), as well as GnomAD (r2.0.1), ExAC (r0.3.1), and BPGD*(V3.1). SecondaryFinding_Var*(v1.1_202.3), dbscSNV (1.1), and SpliceAI (1.3) were used too, alongside dbNSFP (2.9.1), SIft, MutationTaste, and Polyphen2. The pathogenic properties of the variants were classified according to American Society of Medical Genetics and Genomics (ACMG) and American Society of Molecular Pathology (AMP) sequence variation interpretation guidelines [19-22] . The Clingen Working Group on the Interpretation of Sequence Variations and the Society for Clinical Genome Sciences (ACGS) were consulted to refine our interpretation of the guidelines.

Sanger sequencing to validate pedigree

Briefly, total 5 mL of peripheral blood samples from both parents of the fetus was collected, and EDTA was used to prevent coagulation. DNA was extracted using a DNA extraction kit (Tiangen Biochemical Technology [Beijing] Co., Ltd.), and the operation was conducted according to the attached instructions. Suspected pathogenic loci, found by WES, were amplified by PCR. After purification and quantification, the products were sequenced using a ABI 3130 Genetic Analyzer, and the obtained sequences were compared with human wild-type sequences.

Chromosome karyotype analysis

Prenatal cytogenetic analysis of amniotic fluid revealed a normal karyotype: 46, XY (Figure 2).

SNP-array

Analysis via use of the Affymetrix CytoScan 750K Array was normal.

WES

WES revealed homozygous variation of c.1177C>T (NM_024649.4, p.Arg393*) in exon 12 of the BBS1 gene of the fetus (Figure 3). The homozygous variation of c.1177C>T leads to premature termination of protein coding at amino acid position 393, which results in truncated protein production. This ultimately affects normal protein function. According to the ACMG guidelines, c.1177C>T was identified as a pathogenic mutation, with PVS1, PM2, and PM3 as criteria.

These criteria are defined by several standards. PVS1 occurs when the pathogenic mechanism of a disease is loss of function (LOF) and the mutation is detected as nonfunctional mutation. This mutation can occur as a nonsense mutation, frameshift mutation, start codon mutation, or as the deletion of one or more exons. PM2 occurs when variations are not found in the normal control population in the ESP, 1000, and EXAC databases. Finally, PM3 occurs when recessive genetic diseases and the pathogenic variant is detected in the trans position.

WES also revealed heterozygous variation of c.2704G>A (NM_00108052.2.2, p.Asp902Asn) in exon 22 of the fetus’s CC2D2A gene (Figure 4). According to the ACMG guidelines, c.2704G>A was a significant unknown mutation (PM2). PM2: Variations not found in normal control population in ESP database, 1000 database, and EXAC database.

The results of Sanger sequencing for validation of pedigree

Sanger sequencing showed that there were heterozygous mutations at the same gene positions in DNA samples from the fetus’s parents. The parents’ BBS1 genes also exhibited heterozygous variation of exon 12 c.1177C>T (NM_024649.4, p.Arg393 *) (Figure 3). At the same time, the parents also displayed heterozygous variation of the CC2D2A gene, on exon 22 c.2704G>A (NM_00108052.2.2, p.Asp902Asn) (Figure 4).

Pregnancy outcome

The pregnancy was terminated at 25 weeks of gestation, and the parents of the fetus did not consent to a post-induction autopsy.

In this study, an intrauterine ultrasound was conducted to determine the phenotype of a fetus with bilateral-kidney enlargement, enhanced echo, polycystic kidney, and an amniotic fluid index of 2.9 cm (a low level at 24⁺² weeks of gestation). We first used traditional karyotype analysis and an SNP-array to conduct genetic testing on the fetus, but no abnormalities were detected. Further genetic testing of the fetus was then performed using WES. This revealed homozygous variation of c.1177C>T (NM_024649.4, p.Arg393*) in exon 12 of the fetus’s BBS1 gene. Sanger sequencing also showed that there were heterozygous mutations in the same positions on genes in the parents of the fetus. This is consistent with the autosomal recessive inheritance of BBS.

BBS1 (OMIM:209901) is located on chromosome 11q13 and is also known as BBS2L2. At present, 94 pathogenic variants of BBS1 have been reported by the HGMD. Mutation of the BBS1 gene is the most common cause of BBS, and is responsible for 25% of all BBS incidences. The exact type of mutation varies among ethnic groups, with the most common BBS1 variant (p.M390R) accounting for about 80% of all BBS1 mutations in the European population [23, 24]. Mykytyn et al. [25] conducted genetic screening on 129 patients with BBS and found that 30% of them possessed at least one M390R mutation. BBS proteins encoded by different BBS genes are known to function throughout the formation of the BBS complex, including the BBSome, which consists of seven BBS proteins (BBS1, BBS2, BBS4, BBS5, BBS7, BBS8, and BBS9) [26–29]. Mutation of the BBS1 gene results in abnormal function of the BBSome, which, in turn, affects the function of microcilia and various systems in the body [30]. The homozygous variation of c.1177C>T (NM_024649.4, p.arg393*) in exon 12 of the BBS1 gene has not been reported in the Chinese population.

Most BBS1 variants include missense, deletion/insertion, and splicing mutations, and have been reported to produce typical BBS phenotypes [31–34]. According to recent studies, 90% of BBS patients have retinal degeneration in their clinical phenotypes of BBS patients [35], 90% have abnormal renal development and function [36], and 72-92% are obese [37]. Additionally, 63-81% have polydactyly/deformity [38], and more than half have mental retardation and/or gonadal dysplasia [39]. Fetuses in this study had a nonsense variant of BBS1 with biallelic loss of function. Renal abnormalities in the sonographic phenotype of the fetus in our own study are consistent with previously reported clinical abnormalities in the renal development of those with BBS1 mutations. The parents of the fetus did not consent to post-induction autopsy, so it is not clear whether the fetus had other clinical manifestations associated with BBS1 mutations.

WES has the advantage of being able to rapidly and efficiently detect all potentially pathogenic mutations at once [40]. However, its huge data output also brings great challenges when it comes to bioinformatics analysis and clinical interpretation [41]. In this study, WES also revealed heterozygous variation of c.2704G>A (NM_00108052.2.2, p.Asp902Asn) in exon 22 of the fetus’s CC2D2A gene. This gene is primarily involved in the development of COACH syndrome (OMIM:216360), Joubert syndrome 9 (OMIM:612285), and Meckel syndrome 6 (OMIM:612284).

COACH syndrome is an autosomal, recessive, inherited disorder [42], with mental retardation, ataxia (due to cerebellar hypoplasia), and liver fibrosis as typical clinical features. Joubert syndrome is also an autosomal, recessive, inherited disease [43], which manifests clinically through cerebellar ataxia, ocular movement dysfunction, vermis hypoplasia, and thickening of the upper cerebellar foot. Meckel syndrome, another autosomal recessive inherited disease [44], is a fatal multiple congenital anomaly disorder with clinical features that include brain malformation, polycystic kidney malformation, polydactyl deformity, cleft lip and palate, cardiac abnormality, central nervous system malformation, liver fibrosis and bone dysplasia. Heterozygous variation of c.2704G>A (NM_00108052.2.2, p.Asp902Asn) in exon 22 of the CC2D2A gene was also found in the parents of the fetus. According to ACMG guidelines, c.2704G>A was identified as a significant unknown mutation. Further study is needed to determine if the heterozygous variation of c.2704G>A is related to congenital renal dysplasia, along with more relevant future case reports.

In conclusion, we identified the novel nonsense variant c.1177C>T (p.Arg393 *) in the BBS1 gene of a Chinese family. As far as we know, this variant of c.1177C>T, which is considered to be a pathogenic homozygous variant, is the first to be reported in the BBS1 gene in an Asian population. The genetic etiology of the fetus was determined by analyzing the pathogenicity of the c.1177C>T variant in combination with the fetal intrauterine phenotype. It is also necessary to carry out prenatal genetic diagnosis in subsequent pregnancies by the parents of the fetus, as both carry pathological variants of BBS1.

BBS: Bardet-Biedl syndrome; WES: whole exome sequencing; SNP-array: a single nucleotide polymorphism array; CNV: copy number variation; VUS: uncertain clinical significance.

Ethics approval and consent to participate

All experiments were performed in accordance with relevant guidelines and regulations. After being fully informed of the risks, the pregnant couple and their family members signed an informed consent form, decided to terminate the pregnancy, and agreed to genetic tests. The licensing committee of Fujian Maternal and Child Health Hospital (Approval No. 2020KY098) approved the experiments. All methods were carried out in accordance with relevant guidelines and regulations.

Consent for publication

All authors consented to publish and attested to informed consent for publication of identifying information/images in an online open-access publication.

Data availability

All data generated during and/or analyzed during the current study are available by contact the corresponding author.

Competing interests

The authors declare that they have no conflict of interests.

Funding

We thank the patients that participated in this study. This study was funded by the Fujian Provincial Natural Science Foundation (grant nos. 2017J01238) and the training project of young and middle-aged talents in health system of Fujian Province (grant nos. 2020GGA020).

Author contributions

Liangpu Xu and Hailong Huang: Designed the study. Meiying Cai and Min Lin: Wrote the manuscript. Na Lin and Xinrui Wang revised the article. Linjuan Su and Xiaorui Xie performed the statistical analyses. Xiaoqing Wu and Xianguo Fu interpreted the data.

Acknowledgements

Not applicable.

Zaghloul NA, Katsanis N: Mechanistic insights into Bardet-Biedl syndrome, a model ciliopathy. Journal of Clinical Investigation 2009, 119(3):428-437.
Makito H, Wataru S, Kenji I, Ikuya T, Shuji K, Ken S, Hiroyuki B, Kazuhiro O, Hikaru S, Shuichi U: The First Nationwide Survey and Genetic Analyses of Bardet-Biedl Syndrome in Japan. PloS one 2015, 10(9):e0136317.
Georges, Bardet: ON CONGENITAL OBESITY SYNDROME WITH POLYDACTYLY AND RETINITIS PIGMENTOSA (A CONTRIBUTION TO THE STUDY OF CLINICAL FORMS OF HYPOPHYSEAL OBESITY) Thesis, for the degree of Doctor of Medicine. Obesity Research 1995.
Biedl A: A Pair of Siblings with Adiposo-Genital Dystrophy. Obes Res 2012, 3(4):404-404.
Heon E, Kim G, Qin S, Garrison JE, Tavares E, Vincent A, Nuangchamnong N, Scott CA, Slusarski DC, Sheffield VC: Mutations in C8ORF37 cause Bardet Biedl syndrome (BBS21). Human molecular genetics 2016:2283.
Schaefer E, Stoetzel C, Scheidecker S, Geoffroy V, Prasad MK, Redin C, Missotte I, Lacombe D, Mandel JL, Muller J: Identification of a novel mutation confirms the implication of IFT172 (BBS20) in Bardet-Biedl syndrome. Journal of human genetics 2016.
Leppert M, Baird L, Anderson KL, Otterud B, Lupski JR, Lewis RA: Bardet-Biedl syndrome is linked to DNA markers on chromosome 11q and is genetically heterogeneous. Nature genetics 1994, 7(1):108-112.
Kwitek-Black AE, Ca Rmi R, Duyk GM, Buetow KH, Sheffield VC: Linkage of Bardet-Biedl syndrome to chromosome 16q and evidence for non-allelic genetic heterogeneity. Nature genetics 1993, 5(4):392-396.
Katsanis N, Beales PL, Woods MO, Lewis RA, Lupski JR: Mutations in MKKS cause obesity, retinal dystrophy and renal malformations associated with Bardet-Biedl syndrome. Nature genetics 2000, 26(1):67-70.
Yong HK, Joo KS, Seong MW, Park SS, Woo SJ: Retinitis Pigmentosa Associated with Bardet-Biedl Syndrome with BBS9 Gene Mutation in a Korean Patient. Korean Journal of Ophthalmology 2020, 34(1):94-95.
Scerbo M, Costa F, Obringer C, Dollfus H, Marion V: The study of a total and two hypothalamic-specific BBS10 knockout models highlights the importance of systemic inactivation in the obese phenotype in Bardet Biedl Syndrome. Cilia 2015, 4(Suppl 1):P5.
Nikkhah E, Safaralizadeh R, Mohammadiasl J, Tahmasebi M, Golchin N: Identification of Novel Compound heterozygous mutation in BBS12 gene in an Iranian family with Bardet-Biedl syndrome using Targeted Next Generation Sequencing. Cell Journal 2018, 20(2):284-289.
Priya S, Nampoothiri S, Sen P, Sripriya S: Bardet–Biedl syndrome: Genetics, molecular pathophysiology, and disease management. Indian Journal of Ophthalmology 2016, 64(9):620-627.
Williams CL, Uytingco CR, Green WW, Mcintyre JC, Ukhanov K, Zimmerman AD, Shively DT, Zhang L, Nishimura DY, Sheffield VC: Gene Therapeutic Reversal of Peripheral Olfactory Impairment in Bardet-Biedl Syndrome. Molecular Therapy the Journal of the American Society of Gene Therapy 2017, 25(4):904.
Larroca GT: Prenatal diagnosis of Bardet-Biedl syndrome in a case of hyperechogenic kidneys: Clinical use of DNA sequencing. 2018.
Mary L, Chennen K, Stoetzel C, Antin M, Muller J: Bardet-Biedl syndrome - tantenatal presentation of 45 fetuses with biallelic pathogenic variants in known BBS genes. Clinical genetics 2019, 95(3).
South ST, Lee C, Lamb AN, Higgins AW, Kearney HM: ACMG Standards and Guidelines for constitutional cytogenomic microarray analysis, including postnatal and prenatal applications: revision 2013. Genetics in Medicine 2013, 15(11).
Kearney HM, Thorland EC, Brown KK, Quintero-Rivera F, South ST: American College of Medical Genetics standards and guidelines for interpretation and reporting of postnatal constitutional copy number variants. Genetics in Medicine Official Journal of the American College of Medical Genetics 2011, 13(7):680-685.
Richards S, Aziz N, Bale S, Bick D, Das S, Gastier-Foster J, Grody WW, Hegde M, Lyon E, Spector E: Standards and guidelines for the interpretation of sequence variants: a joint consensus recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology. Genetics in Medicine Official Journal of the American College of Medical Genetics 2015, 17(5):405-424.
The ACMG/AMP reputable source criteria for the interpretation of sequence variants. Genetics in Medicine 2018.
Gelb BD, Cavé H, Dillon MW, Gripp KW, Lee JA, Mason-Suares H, Rauen KA, Williams B, Zenker M, Vincent LM: ClinGen's RASopathy Expert Panel consensus methods for variant interpretation. Genetics in Medicine 2018.
Zastrow DB, Baudet H, Shen W, Thomas A, Si Y, Weaver MA, Lager AM, Liu J, Mangels R, Dwight SS: Unique aspects of sequence variant interpretation for inborn errors of metabolism (IEM): The ClinGen IEM Working Group and the Phenylalanine Hydroxylase Gene. Human mutation 2018, 39(11):1569-1580.
Mykytyn K, Nishimura DY, Searby C, Shastri M, Yen HJ, Beck JS, Braun T, Streb LM, Cornier AS, Cox GF: Identification of the gene (BBS1) most commonly involved in Bardet-Biedl syndrome, a complex human obesity syndrome. Nature genetics 2002:435.
Beales PL, Badano JL, Ross AJ, Ansley SJ, Hoskins BE, Kirsten B, Mein CA, Froguel P, Scambler PJ, Lewis RA: Genetic interaction of BBS1 mutations with alleles at other BBS loci can result in non-Mendelian Bardet-Biedl syndrome. The American Journal of Human Genetics 2003, 72(5):1187-1199.
Mykytyn K, Nishimura DY, Searby CC, Beck G, Bugge K, Haines HL, Cornier AS, Cox GF, Fulton AB, Carmi R: Evaluation of complex inheritance involving the most common Bardet-Biedl syndrome locus (BBS1). The American Journal of Human Genetics 2003, 72(2):429-437.
Stoetzel C, Laurier V, Davis EE, Muller J, Dollfus H: BBS10 encodes a vertebrate-specific chaperonin-like protein and is a major BBS locus. Nature genetics 2006, 38(5):521-524.
María á-S, Sheila CS, Diana V: Bardet-Biedl Syndrome as a Chaperonopathy: Dissecting the Major Role of Chaperonin-Like BBS Proteins (BBS6-BBS10-BBS12). Frontiers in Molecular Biosciences 2017, 4:55.
Billingsley G, Bin J, Fieggen KJ, Duncan JL, Gerth C, Ogata K, Wodak SS, Traboulsi EI, Fishman GA, Paterson A: Mutations in chaperonin-like BBS genes are a major contributor to disease development in a multiethnic Bardet-Biedl syndrome patient population. Journal of medical genetics 2010, 47(7):453-463.
Hodges ME, Scheumann N, Wickstead B, Langdale JA, Gull K: Reconstructing the evolutionary history of the centriole from protein components. Journal of Cell Science 2010, 123(9).
Hua J, White SR, Shida T, Schulz S, Aguiar M, Gygi SP, Bazan JF, Nachury MV: The conserved Bardet-Biedl syndrome proteins assemble a coat that traffics membrane proteins to cilia. Cell 2010, 141(7):1208-1219.
Estrada-Cuzcano A, Koenekoop RK, Senechal A, Baere EW, Klevering BJ: BBS1 Mutations in a Wide Spectrum of Phenotypes Ranging From Nonsyndromic Retinitis Pigmentosa to Bardet-Biedl Syndrome. Archives of ophthalmology 2012, 130(11):1425-1432.
Deluca AP, Weed MC, Haas CM, Halder JA, Stone EM: Apparent Usher Syndrome Caused by the Combination of BBS1-Associated Retinitis Pigmentosa and SLC26A4-Associated Deafness. Jama Ophthalmology 2015, 133(8):967.
Bravo-Gil N, Méndez-Vidal C, Romero-Pérez L, Pozo MG-D, Enrique R, Dopazo J, Borrego S, Anti?Olo G: Improving the management of Inherited Retinal Dystrophies by targeted sequencing of a population-specific gene panel. Scientific reports 2016, 6(1):23910.
Comprehensive Rare Variant Analysis via Whole-Genome Sequencing to Determine the Molecular Pathology of Inherited Retinal Disease. American journal of human genetics 2017, 100(1):75-90.
Beales PL, Elcioglu N, Woolf AS, Parker D, Flinter FA: New criteria for improved diagnosis of Bardet-Biedl syndrome: results of a population survey. Journal of medical genetics 1999, 36(6):437-446.
Forsythe E, Beales PL: Bardet-Biedl syndrome. European Journal of Human Genetics 2013, 21(1):8-13.
Iannello S, Bosco P, Cavaleri A, Camuto M, Belfiore F: A review of the literature of Bardet–Biedl disease and report of three cases associated with metabolic syndrome and diagnosed after the age of fifty. Obesity Reviews 2010, 3(2):123-135.
Tayeh MK, Hsan-Jan Y, Beck JS, Searby C, Westfall TA, Hilary G, Sheffield VC, Slusarski DC: Genetic interaction between Bardet-Biedl syndrome genes and implications for limb patterning. Human molecular genetics 2008, 17(13):1956-1967.
Uuralp S, Demircan M, Cetin S, Siirci A: Bardet-Biedl syndrome associated with vaginal atresia: a case report. The Turkish journal of pediatrics 2003, 45(3):273-275.
Wright CF, Mcrae JF, Clayton S, Gallone G, Firth HV: Making new genetic diagnoses with old data: iterative reanalysis and reporting from genome-wide data in 1,133 families with developmental disorders. Genetics in medicine: official journal of the American College of Medical Genetics 2018, 20(10).
Wright, Caroline, F., FitzPatrick, David, R., Firth, Helen, V.: Paediatric genomics: diagnosing rare disease in children. Nature Reviews Genetics 2018.
Mutations in 3 genes (MKS3, CC2D2A and RPGRIP1L) cause COACH syndrome (Joubert syndrome with congenital hepatic fibrosis). Journal of medical genetics 2010, 47(1):8-21.
Devi A, Naushad SM, Lingappa L: Clinical and Molecular Diagnosis of Joubert Syndrome and Related Disorders. Pediatric neurology 2020, 106.
Radhakrishnan P, Nayak SS, Shukla A, Lindstrand A, Girisha KM: Meckel syndrome: Clinical and mutation profile in six fetuses. Clinical genetics 2019, 96(6).

No competing interests reported.

Download PDF

Version 1

posted

You are reading this latest preprint version

Identification of a Novel Homozygous Nonsense Mutation in a Fetus with Bardet-Biedl Syndrome

Status:

Version 1

Abstract

Figures

Background

Materials And Methods

Results

Discussion

Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1