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Lee KH, Stafford AM, Pacheco-Vergara M, Cichewicz K, Canales CP, Seban N, Corea M, Rahbarian D, Bonekamp KE, Gillie GR, Cruz DP, Gill AM, Hwang HE, Uhl KL, Jager TE, Shinawi M, Li X, Obenaus A, Crandall SR, Jeong J, Nord AS, Kim CH, Vogt D. Complimentary vertebrate Wac models exhibit phenotypes relevant to DeSanto-Shinawi Syndrome. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.26.595966. [PMID: 38826421 PMCID: PMC11142245 DOI: 10.1101/2024.05.26.595966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Monogenic syndromes are associated with neurodevelopmental changes that result in cognitive impairments, neurobehavioral phenotypes including autism and attention deficit hyperactivity disorder (ADHD), and seizures. Limited studies and resources are available to make meaningful headway into the underlying molecular mechanisms that result in these symptoms. One such example is DeSanto-Shinawi Syndrome (DESSH), a rare disorder caused by pathogenic variants in the WAC gene. Individuals with DESSH syndrome exhibit a recognizable craniofacial gestalt, developmental delay/intellectual disability, neurobehavioral symptoms that include autism, ADHD, behavioral difficulties and seizures. However, no thorough studies from a vertebrate model exist to understand how these changes occur. To overcome this, we developed both murine and zebrafish Wac/wac deletion mutants and studied whether their phenotypes recapitulate those described in individuals with DESSH syndrome. We show that the two Wac models exhibit craniofacial and behavioral changes, reminiscent of abnormalities found in DESSH syndrome. In addition, each model revealed impacts to GABAergic neurons and further studies showed that the mouse mutants are susceptible to seizures, changes in brain volumes that are different between sexes and relevant behaviors. Finally, we uncovered transcriptional impacts of Wac loss of function that will pave the way for future molecular studies into DESSH. These studies begin to uncover some biological underpinnings of DESSH syndrome and elucidate the biology of Wac, with advantages in each model.
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Affiliation(s)
- Kang-Han Lee
- Department of Biology, Chungnam National University, Daejeon 34134, Korea
| | - April M Stafford
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI, 49503, USA
| | - Maria Pacheco-Vergara
- Department of Molecular Pathology, New York University College of Dentistry, New York, NY 10010, USA
| | - Karol Cichewicz
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis 95618, USA
- Department of Neurobiology, Physiology and Behavior, University of California Davis, Davis 95618, USA
| | - Cesar P Canales
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis 95618, USA
- Department of Neurobiology, Physiology and Behavior, University of California Davis, Davis 95618, USA
| | - Nicolas Seban
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis 95618, USA
- Department of Neurobiology, Physiology and Behavior, University of California Davis, Davis 95618, USA
| | - Melissa Corea
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis 95618, USA
- Department of Neurobiology, Physiology and Behavior, University of California Davis, Davis 95618, USA
| | - Darlene Rahbarian
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis 95618, USA
- Department of Neurobiology, Physiology and Behavior, University of California Davis, Davis 95618, USA
| | - Kelly E. Bonekamp
- Department of Physiology, Michigan State University, East Lansing, MI 48824, USA
| | - Grant R. Gillie
- Department of Physiology, Michigan State University, East Lansing, MI 48824, USA
| | - Dariangelly Pacheco Cruz
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI, 49503, USA
- Neuroscience Program, Michigan State University, East Lansing, MI 48824, USA
| | - Alyssa M Gill
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI, 49503, USA
| | - Hye-Eun Hwang
- Department of Biology, Chungnam National University, Daejeon 34134, Korea
| | - Katie L Uhl
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI, 49503, USA
| | | | - Marwan Shinawi
- Division of Genetics and Genomic Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Xiaopeng Li
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI, 49503, USA
| | - Andre Obenaus
- Director, Preclinical and Translational Imaging Center, School of Medicine, University of California Irvine, Irvine, CA 92697, USA
| | - Shane R Crandall
- Department of Physiology, Michigan State University, East Lansing, MI 48824, USA
- Neuroscience Program, Michigan State University, East Lansing, MI 48824, USA
| | - Juhee Jeong
- Department of Molecular Pathology, New York University College of Dentistry, New York, NY 10010, USA
| | - Alex S Nord
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis 95618, USA
- Department of Neurobiology, Physiology and Behavior, University of California Davis, Davis 95618, USA
| | - Cheol-Hee Kim
- Department of Biology, Chungnam National University, Daejeon 34134, Korea
| | - Daniel Vogt
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI, 49503, USA
- Neuroscience Program, Michigan State University, East Lansing, MI 48824, USA
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Mail C, Yalcintepe S, Eker D, Gurkan H. The Phenotypic Spectrum of Desanto-Shinawi Syndrome: A Comparative Report of the First Reported Case in Turkey. Genet Test Mol Biomarkers 2024; 28:213-217. [PMID: 38613467 DOI: 10.1089/gtmb.2023.0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2024] Open
Abstract
DeSanto-Shinawi syndrome (DESSH, OMIM #616708) is a rare genetic disorder caused by pathogenic variants in the WAC gene. This syndrome is characterized by a wide range of physical and neurological symptoms including dysmorphic features, developmental delay, intellectual disability, and behavioral abnormalities. DESSH was described by DeSanto in 2015, and since then, only a few dozen cases have been reported worldwide. Recent research has focused on identifying the underlying genetic cause of the syndrome as well as exploring potential treatments. In this report, we describe a female case who had dysmorphic features including long palpebral fissures, depressed nasal root, mild bulbous nasal tip, thin upper lip, hypertrichosis, short fingers, and intellectual disability, speech delay, and motor retardation. In addition, she had behavioral abnormalities such as agitation, anxiety, and attention deficit hyperactivity disorder (ADHD). Clinical exome sequencing showed a pathogenic heterozygous nonsense variant in exon 13 of the WAC gene c.1837C>T, p.(Arg613Ter) with de novo inheritance. To the best of our knowledge, this is the first case of DESSH reported from Turkey. We aimed to report this rare syndrome and compare the clinical findings of our case with previously reported cases in the literature.
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Affiliation(s)
- Cisem Mail
- Department of Medical Genetics, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Sinem Yalcintepe
- Department of Medical Genetics, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Damla Eker
- Department of Medical Genetics, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Hakan Gurkan
- Department of Medical Genetics, Trakya University Faculty of Medicine, Edirne, Turkey
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Rudolph HC, Stafford AM, Hwang HE, Kim CH, Prokop JW, Vogt D. Structure-Function of the Human WAC Protein in GABAergic Neurons: Towards an Understanding of Autosomal Dominant DeSanto-Shinawi Syndrome. BIOLOGY 2023; 12:589. [PMID: 37106788 PMCID: PMC10136313 DOI: 10.3390/biology12040589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/29/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023]
Abstract
Dysfunction of the WW domain-containing adaptor with coiled-coil, WAC, gene underlies a rare autosomal dominant disorder, DeSanto-Shinawi syndrome (DESSH). DESSH is associated with facial dysmorphia, hypotonia, and cognitive alterations, including attention deficit hyperactivity disorder and autism. How the WAC protein localizes and functions in neural cells is critical to understanding its role during development. To understand the genotype-phenotype role of WAC, we developed a knowledgebase of WAC expression, evolution, human genomics, and structural/motif analysis combined with human protein domain deletions to assess how conserved domains guide cellular distribution. Then, we assessed localization in a cell type implicated in DESSH, cortical GABAergic neurons. WAC contains conserved charged amino acids, phosphorylation signals, and enriched nuclear motifs, suggesting a role in cellular signaling and gene transcription. Human DESSH variants are found within these regions. We also discovered and tested a nuclear localization domain that impacts the cellular distribution of the protein. These data provide new insights into the potential roles of this critical developmental gene, establishing a platform to assess further translational studies, including the screening of missense genetic variants in WAC. Moreover, these studies are essential for understanding the role of human WAC variants in more diverse neurological phenotypes, including autism spectrum disorder.
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Affiliation(s)
- Hannah C. Rudolph
- Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI 49503, USA
| | - April M. Stafford
- Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI 49503, USA
| | - Hye-Eun Hwang
- Department of Biology, Chungnam National University, Daejeon 34134, Republic of Korea
| | - Cheol-Hee Kim
- Department of Biology, Chungnam National University, Daejeon 34134, Republic of Korea
| | - Jeremy W. Prokop
- Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI 49503, USA
- Office of Research, Corewell Health, Grand Rapids, MI 49503, USA
| | - Daniel Vogt
- Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI 49503, USA
- Neuroscience Program, Michigan State University, East Lansing, MI 48824, USA
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Pasquali D, Torella A, Grandone A, Luongo C, Morleo M, Peduto C, di Fraia R, Selvaggio LD, Allosso F, Accardo G, Zanobio MT, Maitz S, Mariani M, Selicorni A, Banfi S, Nigro V. Patients with DeSanto-Shinawi syndrome: Further extension of phenotype from Italy. Am J Med Genet A 2023; 191:823-830. [PMID: 36420948 DOI: 10.1002/ajmg.a.63061] [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: 03/02/2022] [Revised: 10/11/2022] [Accepted: 10/16/2022] [Indexed: 11/26/2022]
Abstract
Here we describe three patients with neurodevelopmental disorders characterized by mild-to-moderate intellectual disability, mildly dysmorphic features, and hirsutism, all of which carry de novo sequence variants in the WW domain-containing adaptor of the coiled-coil (WAC) gene; two of these-c.167delA, p.(Asn56I1efs*136) and c.1746G>C, p.(Gln582His)-are novel pathogenic variants, and the third-c.1837C>T, p(Arg613*)-has been previously described. Diseases associated with WAC include DeSanto-Shinawi syndrome; to date, de novo heterozygous constitutional pathogenic WAC variants have caused a syndromic form of intellectual disability and mild dysmorphic features in 33 patients, yet potential associations with other clinical manifestations, such as oligomenorrhea and hyperandrogenism, remain unknown, because the phenotypic spectrum of the condition has not yet been delineated. The patient bearing the novel c.167delA WAC gene variant presented a normal psychomotor development, oligomenorrhea, hyperandrogenism, and hirsutism, and hirsutism was also observed in the patient with the c.1746G>C WAC gene variant. Hypertrichosis and hirsutism have been described in nine DeSanto-Shinawi patients, only in 17 of the 33 aforementioned patients thus far reported this aspect, and no hormonal-pattern data are available. In conclusion, we note that the pathogenic c.167delA WAC variant may be associated with a mild phenotype; and in addition to the neurodevelopmental problems nearly all DeSanto-Shinawi patients experience (i.e., intellectual disability and/or developmental delay), we recommend the addition of mild dysmorphic features, hirsutism, and hypertrichosis to this clinical presentation.
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Affiliation(s)
- Daniela Pasquali
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Annalaura Torella
- Genetica Medica, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.,Telethon Institute of Genetics and Medicine (TIGEM), Pozzuoli, Italy
| | - Anna Grandone
- Department of Women's and Children's Health and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Caterina Luongo
- Department of Women's and Children's Health and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Manuela Morleo
- Genetica Medica, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.,Telethon Institute of Genetics and Medicine (TIGEM), Pozzuoli, Italy
| | - Cristina Peduto
- Genetica Medica, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Rosa di Fraia
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Lucia Digitale Selvaggio
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesca Allosso
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giacomo Accardo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Teresa Zanobio
- Genetica Medica, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Silvia Maitz
- Pediatric Genetics Unit, MBBM Foundation, S. Gerardo Hospital, Monza, Italy.,Service of Medical Genetics, Oncologic Institute of Southern Switzerland, Lugano, Switzerland
| | - Milena Mariani
- Department of Pediatrics, S. Fermo Hospital, ASST Lariana, Como, Italy
| | - Angelo Selicorni
- Department of Pediatrics, S. Fermo Hospital, ASST Lariana, Como, Italy
| | - Sandro Banfi
- Genetica Medica, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.,Telethon Institute of Genetics and Medicine (TIGEM), Pozzuoli, Italy
| | - Vincenzo Nigro
- Genetica Medica, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.,Telethon Institute of Genetics and Medicine (TIGEM), Pozzuoli, Italy
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Bolat H, Derin H, Ünsel-Bolat G. Phenotypic and Brain Imaging Findings Associated With a 10p Proximal Deletion Including the WAC Gene: Case Report and Literature Review. Cogn Behav Neurol 2022; 35:221-226. [PMID: 35766809 DOI: 10.1097/wnn.0000000000000309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 02/05/2022] [Indexed: 11/26/2022]
Abstract
Microarray-based techniques are an important testing method in etiological studies of intellectual disability and autism spectrum disorder. Interstitial deletion in the p11-p12 region of chromosome 10 is rare, having been reported in just 12 cases to date. Intellectual disability associated with the WAC gene in this region is referred to as DeSanto-Shinawi syndrome . Although all individuals with p11-p12 region of chromosome 10 deletion share a common phenotype involving intellectual disability and dysmorphic features, individuals with DeSanto-Shinawi syndrome usually do not experience the cardiac and neurologic abnormalities or cryptorchidism associated with a 10p11-p12 deletion. With this case report, we aim to expand the phenotypic spectrum of 10p11-p12 deletion. Our patient was a 9-year-old boy with intellectual disability, autism symptoms, dysmorphic features, and behavioral abnormalities. He had no cardiac problems or neurologic symptoms such as hypotonia, feeding difficulties, or seizures. However, he presented cryptorchidism in addition to symptoms that are consistent with DeSanto-Shinawi syndrome. Array comparative genomic hybridization of genomic DNA isolated from a peripheral blood sample revealed a heterozygous deletion in 10p11.23-p12.1, which contains the WAC gene. We discuss our case in the context of a literature review of candidate genes. It is still difficult to establish genotype-phenotype correlations for neurologic, cardiac, and visual symptoms, and cryptorchidism, in individuals with a 10p11-p12 deletion. As more individuals are diagnosed with deletion in this chromosomal region, the associated phenotypes will become clearer.
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Affiliation(s)
| | - Hatice Derin
- Department of Pediatrics, Division of Child Neurology, Elaziğ Fethi Sekin City Hospital, Balikesir, Turkey
| | - Gül Ünsel-Bolat
- Child and Adolescent Psychiatry, Balikesir University Faculty of Medicine, Balikesir, Turkey
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Toledo-Gotor C, García-Muro C, García-Oguiza A, Poch-Olivé ML, Ruiz-Del Prado MY, Domínguez-Garrido E. Phenotypic comparison of patients affected with DeSanto-Shinawi syndrome: Point mutations in WAC gene versus a 10p12.1 microdeletion including WAC. Mol Genet Genomic Med 2022; 10:e1910. [PMID: 35266333 PMCID: PMC9034681 DOI: 10.1002/mgg3.1910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/14/2022] [Accepted: 01/31/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction DeSanto‐Shinawi syndrome is a rare neurodevelopmental disorder caused by loss‐of‐function variants of WAC, located on chromosome 10p12.1. This syndrome is characterized by dysmorphic facial features, intellectual disability, and behavioral problems. Case report In this case report, we present a new deletion case and summarize the clinical data of previously reported individuals, comparing the similarities and differences between cases caused by point mutations versus those which are caused by deletions in the 10p region. Conclusion Some differential features could facilitate the diagnostic suspicion guiding the optimal diagnostic tests that should be requested in each case scenario.
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Affiliation(s)
- Cristina Toledo-Gotor
- Pediatric Neurology Unit, Department of Pediatrics, San Pedro Hospital, Logroño, Spain
| | | | - Alberto García-Oguiza
- Pediatric Neurology Unit, Department of Pediatrics, Txagorritxu Hospital, Vitoria, Spain
| | - Mª Luisa Poch-Olivé
- Pediatric Neurology Unit, Department of Pediatrics, San Pedro Hospital, Logroño, Spain
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Quental R, Gonçalves D, Rodrigues E, Serrano Gonçalves E, Oliveira J, Parente Freixo J, Leão M. Congenital heart defects associated with pathogenic variants in WAC gene: Expanding the phenotypic and genotypic spectrum of DeSanto-Shinawi syndrome. Am J Med Genet A 2022; 188:1311-1316. [PMID: 34997803 DOI: 10.1002/ajmg.a.62636] [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: 09/06/2021] [Revised: 11/12/2021] [Accepted: 12/15/2021] [Indexed: 11/10/2022]
Abstract
WAC-related intellectual disability, also known as DeSanto-Shinawi syndrome, is a rare autosomal dominant genetic disorder caused by pathogenic variants in WAC gene. This syndrome is characterized by developmental delay, intellectual disability, behavioral abnormalities, and dysmorphic facial features, including deep-set eyes, flat nasal bridge, bulbous nasal tip, and synophrys. Chromosomal deletions at 10p12p11 encompassing WAC gene have been described in patients with a similar phenotype, presenting with developmental delay, intellectual disability, visual impairments, abnormal behavior, and dysmorphic features. An important clinical difference between the two groups of patients, is that those with large deletions frequently present with congenital cardiac defects, which were rarely reported in patients with pathogenic variants in WAC. The genes underlying heart defects in patients with the deletion have not yet been fully clarified. Here, we describe two unrelated Portuguese patients with de novo pathogenic variants in WAC gene, previously unreported in the literature. Both patients present with microcephaly, developmental delay, intellectual disability, behavioral problems, and facial dysmorphisms. Interestingly, the youngest patient has a severe congenital cardiac malformation, showing that intragenic pathogenic WAC variants can also be associated with heart defects. Therefore, this report expands the phenotypic and genotypic spectrum of this rare syndrome and provides deeper insights by comparing the clinical features of our patients with previously reported cases.
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Affiliation(s)
- Rita Quental
- Department of Medical Genetics, Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal
| | - Daniel Gonçalves
- Neurodevelopment Unit, Department of Pediatrics, CHUSJ, Porto, Portugal
| | | | | | - Jorge Oliveira
- CGPP - Centro de Genética Preditiva e Preventiva, IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - João Parente Freixo
- CGPP - Centro de Genética Preditiva e Preventiva, IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Miguel Leão
- Department of Medical Genetics, Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal
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Ho S, Luk HM, Lo IFM. Extending the phenotype of DeSanto-Shinawi syndrome: A case report and literature review. Am J Med Genet A 2021; 188:984-990. [PMID: 34797027 DOI: 10.1002/ajmg.a.62571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/27/2021] [Accepted: 11/06/2021] [Indexed: 01/11/2023]
Abstract
DeSanto-Shinawi syndrome (DESSH, OMIM #616708) is a rare autosomal dominant neurodevelopmental disorder caused by loss-of-function variants in the WAC gene. Affected individuals are characterized by neonatal hypotonia, developmental delay, intellectual disability, behavioral problems, and dysmorphism. Epilepsy is present in some of the patients with DESSH. By far, less than 30 affected individuals have been reported worldwide. Herein, we report a 9-year-old Chinese girl with molecularly substantiated DESSH with a de novo nonsense c. 1648C>T p.(Arg550*) variant identified in the WAC gene. Aside from developmental delay and the characteristic facial gestalt, our proband also exhibited tethered cord syndrome due to filar lipoma and left duplex kidney complicated with hydronephrosis, features not observed in any of the previously reported individuals with DESSH.
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Affiliation(s)
- Stephanie Ho
- Clinical Genetic Service, Department of Health, Hong Kong, China
| | - Ho-Ming Luk
- Clinical Genetic Service, Department of Health, Hong Kong, China
| | - Ivan F M Lo
- Clinical Genetic Service, Department of Health, Hong Kong, China
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