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Vallera RD, Ding Y, Hatanpaa KJ, Bishop JA, Mirfakhraee S, Alli AA, Tevosian SG, Tabebi M, Gimm O, Söderkvist P, Estrada-Zuniga C, Dahia PLM, Ghayee HK. Case report: Two sisters with a germline CHEK2 variant and distinct endocrine neoplasias. Front Endocrinol (Lausanne) 2022; 13:1024108. [PMID: 36440216 PMCID: PMC9682564 DOI: 10.3389/fendo.2022.1024108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/23/2022] [Indexed: 11/09/2022] Open
Abstract
Genetic testing has become the standard of care for many disease states. As a result, physicians treating patients who have tumors often rely on germline genetic testing results for making clinical decisions. Cases of two sisters carrying a germline CHEK2 variant are highlighted whereby possible other genetic drivers were discovered on tumor analysis. CHEK2 (also referred to as CHK2) loss of function has been firmly associated with breast cancer development. In this case report, two siblings with a germline CHEK2 mutation also had distinct endocrine tumors. Pituitary adenoma and pancreatic neuroendocrine tumor (PNET) was found in the first sibling and pheochromocytoma (PCC) discovered in the second sibling. Although pituitary adenomas, PNETs, and PCC have been associated with NF1 gene mutations, the second sister with a PCC did have proven germline CHEK2 with a pathogenic somatic NF1 mutation. We highlight the clinical point that unless the tumor is sequenced, the real driver mutation that is causing the patient's tumor may remain unknown.
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Affiliation(s)
- Raphaelle D. Vallera
- Department of Medicine, Division of Endocrinology, Baylor Scott & White Health, Dallas, TX, United States
| | - Yanli Ding
- Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Kimmo J. Hatanpaa
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Justin A. Bishop
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Sasan Mirfakhraee
- Department of Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Abdel A. Alli
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, FL, United States
| | - Sergei G. Tevosian
- Department of Physiological Sciences, University of Florida, Gainesville, FL, United States
| | - Mouna Tabebi
- Department of Surgery and Department of Biomedical and Clinical Sciences (BKV), Linköping University, Linköping, Sweden
- Division of Cell Biology, Department of Biomedical and Clinical Sciences (BKV), Linköping University, Linköping, Sweden
| | - Oliver Gimm
- Department of Surgery and Department of Biomedical and Clinical Sciences (BKV), Linköping University, Linköping, Sweden
| | - Peter Söderkvist
- Division of Cell Biology, Department of Biomedical and Clinical Sciences (BKV), Linköping University, Linköping, Sweden
- Clinical Genomics Linköping, Science for Life Laboratory, Linköping University, Linköping, Sweden
| | - Cynthia Estrada-Zuniga
- Department of Medicine, Division of Hematology and Medical Oncology, Mays Cancer Center, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Patricia L. M. Dahia
- Department of Medicine, Division of Hematology and Medical Oncology, Mays Cancer Center, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Hans K. Ghayee
- Department of Medicine, Division of Endocrinology & Metabolism, University of Florida, Malcom Randall VA Medical Center, Gainesville, FL, United States
- *Correspondence: Hans K. Ghayee,
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2
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Palit A, Inamadar AC. RASopathies: Dermatologists’ viewpoints. Indian J Dermatol Venereol Leprol 2021; 88:452-463. [DOI: 10.25259/ijdvl_799_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 04/01/2021] [Indexed: 11/04/2022]
Abstract
Ras/mitogen-activated protein kinase pathway dysregulation results in a group of disorders, collectively termed as RASopathies. Neurofibromatosis type 1, Noonan syndrome, Noonan syndrome with multiple lentigines, Noonan syndrome/loose anagen hair, Legius syndrome, Costello syndrome, cardio-facio-cutaneous syndrome and capillary malformation-arteriovenous malformation are the well-recognized RASopathies. These are characterized by multi-organ tumours and hamartomas. Some other features in common are facial dysmorphism, skeletal abnormalities, congenital heart disease, neurocognitive abnormalities and risk of various solid-organ and haematological malignancies. Some of the RASopathies are heterogeneous, caused by several gene mutations resulting in variations in phenotypes and severity ranging from mild to fatal. Significant phenotypic overlaps among different disorders, often makes it difficult to pinpoint a clinical diagnosis. Specific cutaneous manifestations are present in some of the RASopathies and are often the earliest clinical signs/symptoms. Hence, dermatologists contribute significantly as primary care physicians by identifying disorder-specific cutaneous lesions. However, diagnostic work-up and management of these disorders are often multidisciplinary. Confirmation of diagnosis is possible only by genetic mapping in each case. Genetic counseling of the patients and the affected families is an important component of the management. The aim of this review is description of cutaneous manifestations of RASopathies in the background of multi-system involvement to enable dermatologists a comprehensive and logical approach to work up and diagnose such patients in the absence of facility for specific molecular testing.
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Affiliation(s)
| | - Arun C. Inamadar
- Department of Dermatology, Venereology and Leprosy, Shri B. M. Patil Medical College, Hospital and Research Center, BLDE University, Vijayapur, Karnataka, India
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Habulieti X, Sun L, Liu J, Guo K, Yang X, Wang R, Ma D, Zhang X. Phenotypic and genetic characterization of novel variant in the NF1 gene underlying neurofibromatosis type 1 in five Chinese families. SCIENCE CHINA. LIFE SCIENCES 2021; 64:2206-2209. [PMID: 33999308 DOI: 10.1007/s11427-020-1922-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/23/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Xiaerbati Habulieti
- McKusick-Zhang Center for Genetic Medicine, State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China
- The First Affiliated Hospital of XinJiang Medical University, Wulumuqi, 830001, China
| | - Liwei Sun
- McKusick-Zhang Center for Genetic Medicine, State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China
| | - Jiawei Liu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, 100072, China
| | - Kexin Guo
- McKusick-Zhang Center for Genetic Medicine, State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China
| | - Xueting Yang
- McKusick-Zhang Center for Genetic Medicine, State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China
| | - Rongrong Wang
- McKusick-Zhang Center for Genetic Medicine, State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China.
| | - Donglai Ma
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, 100072, China.
| | - Xue Zhang
- McKusick-Zhang Center for Genetic Medicine, State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China
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Borrie SC, Plasschaert E, Callaerts-Vegh Z, Yoshimura A, D'Hooge R, Elgersma Y, Kushner SA, Legius E, Brems H. MEK inhibition ameliorates social behavior phenotypes in a Spred1 knockout mouse model for RASopathy disorders. Mol Autism 2021; 12:53. [PMID: 34311771 PMCID: PMC8314535 DOI: 10.1186/s13229-021-00458-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 07/12/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND RASopathies are a group of disorders that result from mutations in genes coding for proteins involved in regulating the Ras-MAPK signaling pathway, and have an increased incidence of autism spectrum disorder (ASD). Legius syndrome is a rare RASopathy caused by loss-of-function mutations in the SPRED1 gene. The patient phenotype is similar to, but milder than, Neurofibromatosis type 1-another RASopathy caused by loss-of-function mutations in the NF1 gene. RASopathies exhibit increased activation of Ras-MAPK signaling and commonly manifest with cognitive impairments and ASD. Here, we investigated if a Spred1-/- mouse model for Legius syndrome recapitulates ASD-like symptoms, and whether targeting the Ras-MAPK pathway has therapeutic potential in this RASopathy mouse model. METHODS We investigated social and communicative behaviors in Spred1-/- mice and probed therapeutic mechanisms underlying the observed behavioral phenotypes by pharmacological targeting of the Ras-MAPK pathway with the MEK inhibitor PD325901. RESULTS Spred1-/- mice have robust increases in social dominance in the automated tube test and reduced adult ultrasonic vocalizations during social communication. Neonatal ultrasonic vocalization was also altered, with significant differences in spectral properties. Spred1-/- mice also exhibit impaired nesting behavior. Acute MEK inhibitor treatment in adulthood with PD325901 reversed the enhanced social dominance in Spred1-/- mice to normal levels, and improved nesting behavior in adult Spred1-/- mice. LIMITATIONS This study used an acute treatment protocol to administer the drug. It is not known what the effects of longer-term treatment would be on behavior. Further studies titrating the lowest dose of this drug that is required to alter Spred1-/- social behavior are still required. Finally, our findings are in a homozygous mouse model, whereas patients carry heterozygous mutations. These factors should be considered before any translational conclusions are drawn. CONCLUSIONS These results demonstrate for the first time that social behavior phenotypes in a mouse model for RASopathies (Spred1-/-) can be acutely reversed. This highlights a key role for Ras-MAPK dysregulation in mediating social behavior phenotypes in mouse models for ASD, suggesting that proper regulation of Ras-MAPK signaling is important for social behavior.
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Affiliation(s)
- Sarah C Borrie
- Department of Human Genetics, KU Leuven, O&N1 Herestraat 49, Box 607, 3000, Leuven, Belgium
| | - Ellen Plasschaert
- Department of Human Genetics, KU Leuven, O&N1 Herestraat 49, Box 607, 3000, Leuven, Belgium
| | | | - Akihiko Yoshimura
- Department of Microbiology and Immunology, Keio University School of Medicine, Tokyo, Japan
| | - Rudi D'Hooge
- Laboratory for Biological Psychology, KU Leuven, Leuven, Belgium
| | - Ype Elgersma
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Neuroscience, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Steven A Kushner
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Eric Legius
- Department of Human Genetics, KU Leuven, O&N1 Herestraat 49, Box 607, 3000, Leuven, Belgium
| | - Hilde Brems
- Department of Human Genetics, KU Leuven, O&N1 Herestraat 49, Box 607, 3000, Leuven, Belgium.
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Uludağ Alkaya D, Lissewski C, Yeşil G, Zenker M, Tüysüz B. Expanding the clinical phenotype of RASopathies in 38 Turkish patients, including the rare LZTR1, RAF1, RIT1 variants, and large deletion in NF1. Am J Med Genet A 2021; 185:3623-3633. [PMID: 34184824 DOI: 10.1002/ajmg.a.62410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 04/30/2021] [Accepted: 06/12/2021] [Indexed: 12/31/2022]
Abstract
RASopathies are a group of disorders caused by pathogenic variants in the genes encoding Ras/mitogen-activated protein kinase pathway and share overlapping clinical and molecular features. This study is aimed to describe the clinical and molecular features of 38 patients with RASopathies. Sanger or targeted next-generation sequencing of related genes and multiplex ligation-dependent-probe amplification analysis for NF1 were performed. The pathogenic variant detection rate was 94.4%. While PTPN11 was responsible for 50% of 18 patients with Noonan syndrome (NS), SOS1, LZTR1, RIT1, and RAF1 were responsible for the remaining 27.8%, 11.1%, 5.5%, and 5.5%, respectively. Three variants in LZTR1 were novel, of which two were identified in the compound heterozygous state in a patient with intellectual disability and hypertrophic cardiomyopathy, whereas the third variant was found in the heterozygous state in a patient with pulmonary stenosis and normal intelligence. We described pyloric stenosis, knee dislocation, and cleft palate in patients with SOS1, RIT1, and RAF1 variants, respectively, that was not previously reported. We detected a PTPN11 variant in three patients from same family with NS with multiple lentigines. BRAF and MAP2K2 variants were found in eight patients with Cardiofaciocutaneous syndrome. Two variants in HRAS were detected in two Costello syndrome patients, one with a mild and the other with a severe phenotype. While large NF1 deletions were identified in four Neurofibromatosis-NS patients with intellectual disability, intelligence was normal in one patient with missense variant. In conclusion, this study provided three novel variants in LZTR1 and expanded the clinical phenotype of rare RASopathies.
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Affiliation(s)
- Dilek Uludağ Alkaya
- Department of Pediatric Genetics, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Christina Lissewski
- Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany
| | - Gözde Yeşil
- Department of Medical Genetics, Medical School, Bezmialem University, Istanbul, Turkey
| | - Martin Zenker
- Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany
| | - Beyhan Tüysüz
- Department of Pediatric Genetics, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Güneş N, Yeşil G, Geyik F, Kasap B, Celkan T, Kebudi R, Tüysüz B. Neurofibromatosis type 1: Expanded variant spectrum with multiplex ligation-dependent probe amplification and genotype-phenotype correlation in 138 Turkish patients. Ann Hum Genet 2021; 85:155-165. [PMID: 33877690 DOI: 10.1111/ahg.12422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the variant spectrum and genotype-phenotype correlations in a Turkish cohort with Neurofibromatosis Type-1 (NF1). MATERIALS AND METHODS We retrospectively investigated the clinical and molecular data of 138 NF1 patients from 129 families who had been followed-up for a median of 3.9 (1.25-18.5) years. RESULTS NF1 sequencing revealed 73 different intragenic variants, 19 of which were novel. Seven large deletions were detected by multiplex ligation-dependent probe amplification (MLPA) analyses. The total detection rate of pathogenic NF1 variants was found to be 87.1%. Comparing age groups, cutaneous neurofibromas, freckling, and Lisch nodules were more prevalent in patients older than 12 years (p > .05). Optic glioma detected in 17.3% of the patients and was significantly more common before the age of 6 (p > .001). Other solid tumors developed in 5% of the patients. There was no genotype-phenotype correlation between patients with truncating and nontruncating variants. However, six out of seven patients with large deletions had significant developmental delay, one patient with the c.2970_2972delAAT (p.Met992del) variant had only typical pigmentary features, and another patient with the c.4267A > G (p.Lys1423Glu) variant had CALMs, freckling, neurofibromas, and Noonan-like phenotype. CONCLUSIONS We described 19 novel variants and seven large deletions in NF1. Applying MLPA assay in NF1 is useful in expanding the molecular diagnosis. Although very limited genotype-phenotype correlation has been reported in NF1, the fact that specific phenotypic findings were observed in our patients with large deletions and two intragenic variants supports the studies published recently.
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Affiliation(s)
- Nilay Güneş
- Cerrahpaşa Medical Faculty, Department of Pediatric Genetics, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Gözde Yeşil
- Faculty of Medicine, Department of Medical Genetics, Bezmialem Vakif University, Istanbul, Turkey
| | - Filiz Geyik
- Cerrahpaşa Medical Faculty, Department of Pediatric Genetics, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Büşra Kasap
- Cerrahpaşa Medical Faculty, Department of Pediatric Genetics, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Tiraje Celkan
- Cerrahpaşa Medical Faculty, Department of Pediatric Oncology, Istanbul University-Cerrahpaşa, Istanbul
| | - Rejin Kebudi
- Department of Pediatric Oncology, Istanbul University, Oncology Institute, Istanbul, Turkey
| | - Beyhan Tüysüz
- Cerrahpaşa Medical Faculty, Department of Pediatric Genetics, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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Bertola DR, Castro MAA, Yamamoto GL, Honjo RS, Ceroni JR, Buscarilli MM, Freitas AB, Malaquias AC, Pereira AC, Jorge AAL, Passos‐Bueno MR, Kim CA. Phenotype–genotype analysis of 242 individuals with
RASopathies
: 18‐year experience of a tertiary center in Brazil. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:896-911. [DOI: 10.1002/ajmg.c.31851] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Débora R. Bertola
- Unidade de Genética Instituto da Criança do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
- Instituto de Biociências Universidade de São Paulo São Paulo Brazil
| | - Matheus A. A. Castro
- Unidade de Genética Instituto da Criança do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Guilherme L. Yamamoto
- Unidade de Genética Instituto da Criança do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Rachel S. Honjo
- Unidade de Genética Instituto da Criança do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - José Ricardo Ceroni
- Unidade de Genética Instituto da Criança do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Michele M. Buscarilli
- Unidade de Genética Instituto da Criança do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Amanda B. Freitas
- Unidade de Genética Instituto da Criança do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Alexsandra C. Malaquias
- Unidade de Endocrinologia‐Genetica LIM 25, Disciplina de Endocrinologia da Faculdade de Medicina da Universidade de Sao Paulo São Paulo Brazil
| | - Alexandre C. Pereira
- Laboratório de Genética e Cardiologia Molecular Instituto do Coração, do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Alexander A. L. Jorge
- Unidade de Endocrinologia‐Genetica LIM 25, Disciplina de Endocrinologia da Faculdade de Medicina da Universidade de Sao Paulo São Paulo Brazil
| | | | - Chong A. Kim
- Unidade de Genética Instituto da Criança do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
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Witkowski L, Dillon MW, Murphy E, S Lebo M, Mason-Suares H. Expanding the Noonan spectrum/RASopathy NGS panel: Benefits of adding NF1 and SPRED1. Mol Genet Genomic Med 2020; 8:e1180. [PMID: 32107864 PMCID: PMC7196473 DOI: 10.1002/mgg3.1180] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 12/28/2019] [Accepted: 01/30/2020] [Indexed: 01/13/2023] Open
Abstract
Background RASopathies are a group of disorders caused by disruptions to the RAS‒MAPK pathway. Despite being in the same pathway, Neurofibromatosis Type 1 (NF1) and Legius syndrome (LS) typically present with phenotypes distinct from Noonan spectrum disorders (NSDs). However, some NF1/LS individuals also exhibit NSD phenotypes, often referred to as Neurofibromatosis‐Noonan syndrome (NFNS), and may be mistakenly evaluated for NSDs, delaying diagnosis, and affecting patient management. Methods A derivation cohort of 28 patients with a prior negative NSD panel and either NFNS or a suspicion of NSD and café‐au‐lait spots underwent NF1 and SPRED1 sequencing. To further determine the utility and burden of adding these genes, a validation cohort of 505 patients with a suspected RASopathy were tested on a 14‐gene RASopathy‐associated panel. Results In the derivation cohort, six (21%) patients had disease‐causing NF1 or SPRED1 variants. In the validation cohort, 11 (2%) patients had disease‐causing variants and 15 (3%) had variants of uncertain significance in NF1 or SPRED1. Of those with disease‐causing variants, 5/17 only had an NSD diagnosis. Conclusions Adding NF1 and SPRED1 to RASopathy panels can speed diagnosis and improve patient management, without significantly increasing the burden of inconclusive results.
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Affiliation(s)
- Leora Witkowski
- Departments of Pathology, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA.,Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge, MA, USA
| | - Mitchell W Dillon
- Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge, MA, USA
| | - Elissa Murphy
- Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge, MA, USA
| | - Matthew S Lebo
- Departments of Pathology, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA.,Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge, MA, USA
| | - Heather Mason-Suares
- Departments of Pathology, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA.,Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge, MA, USA
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