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Yeshareem L, Yacobovich J, Lebel A, Noy-Lotan S, Dgany O, Krasnov T, Berger Pinto G, Oniashvili N, Mardoukh J, Bielorai B, Laor R, Mandel-Shorer N, Ben Barak A, Levin C, Asleh M, Miskin H, Revel-Vilk S, Levin D, Benish M, Zuckerman T, Wolach O, Pazgal I, Brik Simon D, Gilad O, Yanir AD, Goldberg TA, Izraeli S, Tamary H, Steinberg-Shemer O. Genetic backgrounds and clinical characteristics of congenital neutropenias in Israel. Eur J Haematol 2024; 113:146-162. [PMID: 38600884 DOI: 10.1111/ejh.14197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/19/2024] [Accepted: 02/26/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Congenital neutropenias are characterized by severe infections and a high risk of myeloid transformation; the causative genes vary across ethnicities. The Israeli population is characterized by an ethnically diverse population with a high rate of consanguinity. OBJECTIVE To evaluate the clinical and genetic spectrum of congenital neutropenias in Israel. METHODS We included individuals with congenital neutropenias listed in the Israeli Inherited Bone Marrow Failure Registry. Sanger sequencing was performed for ELANE or G6PC3, and patients with wild-type ELANE/G6PC3 were referred for next-generation sequencing. RESULTS Sixty-five patients with neutropenia were included. Of 51 patients with severe congenital neutropenia, 34 were genetically diagnosed, most commonly with variants in ELANE (15 patients). Nine patients had biallelic variants in G6PC3, all of consanguineous Muslim Arab origin. Other genes involved were SRP54, JAGN1, TAZ, and SLC37A4. Seven patients had cyclic neutropenia, all with pathogenic variants in ELANE, and seven had Shwachman-Diamond syndrome caused by biallelic SBDS variants. Eight patients (12%) developed myeloid transformation, including six patients with an unknown underlying genetic cause. Nineteen (29%) patients underwent hematopoietic stem cell transplantation, mostly due to insufficient response to treatment with granulocyte-colony stimulating factor or due to myeloid transformation. CONCLUSIONS The genetic spectrum of congenital neutropenias in Israel is characterized by a high prevalence of G6PC3 variants and an absence of HAX1 mutations. Similar to other registries, for 26% of the patients, a molecular diagnosis was not achieved. However, myeloid transformation was common in this group, emphasizing the need for close follow-up.
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Affiliation(s)
- Lital Yeshareem
- Kipper Institute of Allergy and Immunology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Joanne Yacobovich
- Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Lebel
- Pediatric Nephrology Unit, HaEmek Medical Center, Afula, Israel
| | - Sharon Noy-Lotan
- Pediatric Hematology Laboratory, Felsenstein Medical Research Center, Petah Tikva, Israel
| | - Orly Dgany
- Pediatric Hematology Laboratory, Felsenstein Medical Research Center, Petah Tikva, Israel
| | - Tanya Krasnov
- Pediatric Hematology Laboratory, Felsenstein Medical Research Center, Petah Tikva, Israel
| | - Galit Berger Pinto
- Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Nino Oniashvili
- Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Jacques Mardoukh
- Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Bella Bielorai
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Pediatric Hematology and Oncology, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Ruth Laor
- Hematology Service, Bnei Zion Medical Center, Haifa, Israel
| | - Noa Mandel-Shorer
- Department of Pediatric Hematology-Oncology, Ruth Rappaport Children's Hospital, Rambam Healthcare Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel
| | - Ayelet Ben Barak
- Department of Pediatric Hematology-Oncology, Ruth Rappaport Children's Hospital, Rambam Healthcare Campus, Haifa, Israel
| | - Carina Levin
- Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel
- Pediatric Hematology Unit and Research Laboratory, Emek Medical Center, Afula, Israel
| | - Mahdi Asleh
- Pediatric Hematology, Soroka University Medical Center, Ben-Gurion University, Beer Sheva, Israel
| | - Hagit Miskin
- Pediatric Hematology, Soroka University Medical Center, Ben-Gurion University, Beer Sheva, Israel
| | - Shoshana Revel-Vilk
- Pediatric Hematology/Oncology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Dror Levin
- Department of Pediatric Hemato-Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Marganit Benish
- Department of Pediatric Hemato-Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Tsila Zuckerman
- Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel
- Hematology and Bone Marrow Transplantation Institute, Rambam Healthcare Campus, Haifa, Israel
| | - Ofir Wolach
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Idit Pazgal
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Comprehensive Center of Thalassemia, Hemoglobinopathies & Rare Anemias, Institute of Hematology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Dafna Brik Simon
- Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Oded Gilad
- Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf David Yanir
- Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Tracie Alison Goldberg
- Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Shai Izraeli
- Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hannah Tamary
- Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Hematology Laboratory, Felsenstein Medical Research Center, Petah Tikva, Israel
| | - Orna Steinberg-Shemer
- Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Hematology Laboratory, Felsenstein Medical Research Center, Petah Tikva, Israel
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2
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Zhen X, Betti M, Kars ME, Patterson A, Medina-Torres EA, Scheffler Mendoza SC, Herrera Sánchez DA, Lopez-Herrera G, Svyryd Y, Mutchinick O, Gamazon E, Rathmell J, Itan Y, Markle J, O'Farrill Romanillos P, Lugo-Reyes SO, Martinez-Barricarte R. Molecular and clinical characterization of a founder mutation causing G6PC3 deficiency. RESEARCH SQUARE 2024:rs.3.rs-4595246. [PMID: 39041036 PMCID: PMC11261954 DOI: 10.21203/rs.3.rs-4595246/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
G6PC3 deficiency is a monogenic immunometabolic disorder that causes syndromic congenital neutropenia. Patients display heterogeneous extra-hematological manifestations, contributing to delayed diagnosis. Here, we investigated the origin and functional consequence of the G6PC3 c.210delC variant found in patients of Mexican origin. Based on the shared haplotypes amongst carriers of the c.210delC mutation, we estimated that this variant originated from a founder effect in a common ancestor. Furthermore, by ancestry analysis, we concluded that it originated in the indigenous Mexican population. At the protein level, we showed that this frameshift mutation leads to an aberrant protein expression in overexpression and patient-derived cells. G6PC3 pathology is driven by the intracellular accumulation of the metabolite 1,5-anhydroglucitol-6-phosphate (1,5-AG6P) that inhibits glycolysis. We characterized how the variant c.210delC impacts glycolysis by performing extracellular flux assays on patient-derived cells. When treated with 1,5-anhydroglucitol (1,5-AG), the precursor to 1,5-AG6P, patient-derived cells exhibited markedly reduced engagement of glycolysis. Finally, we compared the clinical presentation of patients with the mutation c.210delC and all other G6PC3 deficient patients reported in the literature to date, and we found that c.210delC carriers display all prominent clinical features observed in prior G6PC3 deficient patients. In conclusion, G6PC3 c.210delC is a loss-of-function mutation that arose from a founder effect in the indigenous Mexican population. These findings may facilitate the diagnosis of additional patients in this geographical area. Moreover, the in vitro 1,5-AG-dependent functional assay used in our study could be employed to assess the pathogenicity of additional G6PC3 variants.
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Affiliation(s)
- Xin Zhen
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center
| | - Michael Betti
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center
| | - Meltem Ece Kars
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai
| | - Andrew Patterson
- Division of Molecular Pathogenesis, Department of Medicine, Vanderbilt University Medical Center
| | | | | | | | | | - Yevgeniya Svyryd
- Department of Genetics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
| | - Osvaldo Mutchinick
- Department of Genetics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
| | - Eric Gamazon
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center
| | - Jeffrey Rathmell
- Division of Molecular Pathogenesis, Department of Medicine, Vanderbilt University Medical Center
| | - Yuval Itan
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai
| | - Janet Markle
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center
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Zhen X, Betti MJ, Kars ME, Patterson A, Medina-Torres EA, Scheffler Mendoza SC, Herrera Sánchez DA, Lopez-Herrera G, Svyryd Y, Mutchinick OM, Gamazon E, Rathmell JC, Itan Y, Markle J, O’Farrill Romanillos P, Lugo-Reyes SO, Martinez-Barricarte R. Molecular and clinical characterization of a founder mutation causing G6PC3 deficiency. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.13.24307299. [PMID: 38798393 PMCID: PMC11118594 DOI: 10.1101/2024.05.13.24307299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Background G6PC3 deficiency is a rare genetic disorder that causes syndromic congenital neutropenia. It is driven by the intracellular accumulation of a metabolite named 1,5-anhydroglucitol-6-phosphate (1,5-AG6P) that inhibits glycolysis. Patients display heterogeneous extra-hematological manifestations, contributing to delayed diagnosis. Objective The G6PC3 c.210delC variant has been identified in patients of Mexican origin. We set out to study the origin and functional consequence of this mutation. Furthermore, we sought to characterize the clinical phenotypes caused by it. Methods Using whole-genome sequencing data, we conducted haplotype analysis to estimate the age of this allele and traced its ancestral origin. We examined how this mutation affected G6PC3 protein expression and performed extracellular flux assays on patient-derived cells to characterize how this mutation impacts glycolysis. Finally, we compared the clinical presentations of patients with the c.210delC mutation relative to other G6PC3 deficient patients published to date. Results Based on the length of haplotypes shared amongst ten carriers of the G6PC3 c.210delC mutation, we estimated that this variant originated in a common ancestor of indigenous American origin. The mutation causes a frameshift that introduces a premature stop codon, leading to a complete loss of G6PC3 protein expression. When treated with 1,5-anhydroglucitol (1,5-AG), the precursor to 1,5-AG6P, patient-derived cells exhibited markedly reduced engagement of glycolysis. Clinically, c.210delC carriers display all the clinical features of syndromic severe congenital neutropenia type 4 observed in prior reports of G6PC3 deficiency. Conclusion The G6PC3 c.210delC is a loss-of-function mutation that arose from a founder effect in the indigenous Mexican population. These findings may facilitate the diagnosis of additional patients in this geographical area. Moreover, the in vitro 1,5-AG-dependent functional assay used in our study could be employed to assess the pathogenicity of additional G6PC3 variants.
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Affiliation(s)
- Xin Zhen
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Molecular Pathogenesis, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael J Betti
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Meltem Ece Kars
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew Patterson
- Division of Molecular Pathogenesis, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center for Immunobiology, Nashville, TN, USA
| | | | | | | | - Gabriela Lopez-Herrera
- Immune deficiencies laboratory, National Institute of Pediatrics, Health Secretariat, Mexico City, Mexico
| | - Yevgeniya Svyryd
- Department of Genetics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Osvaldo M. Mutchinick
- Department of Genetics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Eric Gamazon
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeffrey C Rathmell
- Division of Molecular Pathogenesis, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center for Immunobiology, Nashville, TN, USA
- Vanderbilt Institute for Infection, Immunology and Inflammation, Nashville, TN, USA
| | - Yuval Itan
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Janet Markle
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Molecular Pathogenesis, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center for Immunobiology, Nashville, TN, USA
- Vanderbilt Institute for Infection, Immunology and Inflammation, Nashville, TN, USA
| | | | - Saul Oswaldo Lugo-Reyes
- Immune deficiencies laboratory, National Institute of Pediatrics, Health Secretariat, Mexico City, Mexico
| | - Ruben Martinez-Barricarte
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Molecular Pathogenesis, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center for Immunobiology, Nashville, TN, USA
- Vanderbilt Institute for Infection, Immunology and Inflammation, Nashville, TN, USA
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4
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Dhayhi NS, Mahnashi MA, Mokhasha AI, Ahmed LF, Shamakhi AE, Ageel AA, Tohary MA, Alhazmi AH. Case report of congenital neutropenia type 4 with glucose-6-phosphatase catalytic subunit 3 (G6PC3) deficiency. Clin Case Rep 2024; 12:e8540. [PMID: 38385051 PMCID: PMC10879636 DOI: 10.1002/ccr3.8540] [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: 07/28/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/23/2024] Open
Abstract
Congenital neutropenia syndromes encompass a group of genetic disorders characterized by persistent neutropenia and recurrent infections inherited in an autosomal recessive, dominant, or X-linked manner. These syndromes arise from mutations in various genes, and one of the significant genes involved is glucose-6-phosphatase catalytic subunit 3 (G6PC3), giving rise to a condition known as Dursun syndrome. As per existing knowledge, a total of 92 cases of Dursun syndrome have been reported globally, including eight cases from Saudi Arabia. Our study identified two additional cases exhibiting neutropenia since the early postnatal period and recurrent admissions due to infections. Additionally, these patients presented with oral ulcers, chronic diarrhea, and anomalies affecting the cardiac and genitourinary systems. The rising incidence of congenital neutropenia on a global scale necessitates heightened vigilance among clinicians to ensure thorough follow-up of patients with neutropenia. This proactive approach can lead to early detection and appropriate management of associated complications, ultimately improving patient outcomes.
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Affiliation(s)
- Nabil S Dhayhi
- Pediatric Infectious Disease Unit King Fahad Central Hospital Jazan Saudi Arabia
| | - Mohammed A Mahnashi
- Pediatric Genetic Diseases Unit King Fahad Central Hospital Jazan Saudi Arabia
| | | | - Lana F Ahmed
- Pediatric Department King Fahad Central Hospital Jazan Saudi Arabia
| | - Ahmed E Shamakhi
- Pediatric Allergy/Immunology Unit King Fahad Central Hospital Jazan Saudi Arabia
| | - Adeeb A Ageel
- Pediatric Hematology Unit Kung Fahad Central Hospital Jazan Saudi Arabia
| | - Mohammed A Tohary
- Pediatric Hematology Unit Kung Fahad Central Hospital Jazan Saudi Arabia
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5
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Leal-Anaya P, Kimball TN, Yanez-Felix AL, Fiesco-Roa MÓ, García-de Teresa B, Monsiváis A, Juárez-Velázquez R, Lieberman E, Villarroel C, Yokoyama E, Fernández-Hernández L, Rivera-Osorio A, Sosa D, Ortiz Sandoval MM, López-Santiago N, Frías S, del Castillo V, Rodríguez A. Inherited bone marrow failure syndromes: phenotype as a tool for early diagnostic suspicion at a major reference center in Mexico. Front Genet 2024; 14:1293929. [PMID: 38327701 PMCID: PMC10848162 DOI: 10.3389/fgene.2023.1293929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/26/2023] [Indexed: 02/09/2024] Open
Abstract
Introduction: The inherited bone marrow failure syndromes (IBMFSs) are a group of rare disorders characterized by bone marrow failure (BMF), physical abnormalities, and an increased risk of neoplasia. The National Institute of Pediatrics (INP) is a major medical institution in Mexico, where patients with BMF receive a complete approach that includes paraclinical tests. Readily recognizable features, such as the hematological and distinctive physical phenotypes, identified by clinical dysmorphologists, remain crucial for the diagnosis and management of these patients, particularly in circumstances where next-generation sequencing (NGS) is not easily available. Here, we describe a group of Mexican patients with a high clinical suspicion of an IBMFS. Methods: We performed a systematic retrospective analysis of the medical records of patients who had a high IBMFS suspicion at our institution from January 2018 to July 2021. An initial assessment included first ruling out acquired causes of BMF by the Hematology Department and referral of the patient to the Department of Human Genetics for physical examination to search for specific phenotypes suggesting an IBMFS. Patients with high suspicion of having an IBMFS were classified into two main groups: 1) specific IBMFS, including dyskeratosis congenita (DC), Diamond-Blackfan anemia (DBA), Shwachman-Diamond syndrome (SDS), thrombocytopenia with absent radii (TAR), and severe congenital neutropenia (SCN); 2) undefined IBMFS (UI). Results: We established a high suspicion of having an IBMFS in 48 patients. At initial evaluation, the most common hematologic features were bicytopenia (20%) and aplastic anemia (16%); three patients received hematopoietic stem cell transplantation. Among patients with a suspicion of an IBMFS, the most common physical abnormality was minor craniofacial features in 83% of patients and neurodevelopmental disorders in 52%. The specific suspicions that we built were DBA (31%), SDS (18%), DC (14%), TAR (4%), and SCN (4%), whereas 27% of cases remained as undefined IBMFS. SDS, TAR, and SCN were more commonly suspected at an earlier age (<1 year), followed by DBA (2 years) and DC (5 years). Conclusions: Thorough examination of reported clinical data allowed us to highly suspect a specific IBMFS in approximately 70% of patients; however, an important number of patients remained with suspicion of an undefined IBMFS. Implementation of NGS and telomere length measurement are forthcoming measures to improve IBMFS diagnosis in Mexico.
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Affiliation(s)
- Paula Leal-Anaya
- Departamento de Medicina Genómica y Toxicología Ambiental, Universidad Nacional Autónoma de México, México City, Mexico
- Laboratorio de Falla Medular y Carcinogénesis, Instituto Nacional de Pediatría, México City, Mexico
- Posgrado en Ciencias Biomédicas, Universidad Nacional Autónoma de México, México City, Mexico
| | - Tamara N. Kimball
- Laboratorio de Falla Medular y Carcinogénesis, Instituto Nacional de Pediatría, México City, Mexico
| | - Ana Lucia Yanez-Felix
- Departamento de Genética Humana, Instituto Nacional de Pediatría, México City, Mexico
| | - Moisés Ó. Fiesco-Roa
- Programa de Maestría y Doctorado en Ciencias Médicas, Odontológicas y de la Salud, Universidad Nacional Autónoma de México, México City, Mexico
- Laboratorio de Citogenética, Instituto Nacional de Pediatría, México City, Mexico
| | - Benilde García-de Teresa
- Posgrado en Ciencias Biomédicas, Universidad Nacional Autónoma de México, México City, Mexico
- Laboratorio de Citogenética, Instituto Nacional de Pediatría, México City, Mexico
| | - Angélica Monsiváis
- Departamento de Hematología, Instituto Nacional de Pediatría, México City, Mexico
| | | | - Esther Lieberman
- Departamento de Genética Humana, Instituto Nacional de Pediatría, México City, Mexico
| | - Camilo Villarroel
- Departamento de Genética Humana, Instituto Nacional de Pediatría, México City, Mexico
| | - Emiy Yokoyama
- Departamento de Genética Humana, Instituto Nacional de Pediatría, México City, Mexico
| | | | - Anet Rivera-Osorio
- Laboratorio de Análisis Genéticos Especializados México (LAGEM), México City, Mexico
| | - David Sosa
- Laboratorio de Análisis Genéticos Especializados México (LAGEM), México City, Mexico
| | | | - Norma López-Santiago
- Departamento de Hematología, Instituto Nacional de Pediatría, México City, Mexico
| | - Sara Frías
- Departamento de Medicina Genómica y Toxicología Ambiental, Universidad Nacional Autónoma de México, México City, Mexico
- Laboratorio de Citogenética, Instituto Nacional de Pediatría, México City, Mexico
| | - Victoria del Castillo
- Departamento de Genética Humana, Instituto Nacional de Pediatría, México City, Mexico
| | - Alfredo Rodríguez
- Departamento de Medicina Genómica y Toxicología Ambiental, Universidad Nacional Autónoma de México, México City, Mexico
- Laboratorio de Falla Medular y Carcinogénesis, Instituto Nacional de Pediatría, México City, Mexico
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