Recent medical advances have significantly improved the life expectancy of individuals with congenital heart disease (CHD); however, these children remain at increased risk of co‐occurring neurodevelopmental disorders (NDD), such as attention‐deficit/hyperactivity disorder and autism spectrum disorder. Although prenatal environmental factors, including placental dysfunction and altered oxygen levels in utero, as well as postnatal events such as cardiac surgery, may contribute to this increased risk, shared genetic factors may also underlie both conditions. Therefore, this study is aimed at investigating genomic, transcriptomic and epigenomic findings in patients with NDD and/or CHD using an integrative multiomic approach. A cohort of 14 trios and one duo was recruited: Two probands had both NDD and CHD, two had CHD only and 11 had NDD only. Blood samples were analysed using whole‐genome sequencing, RNA sequencing and DNA methylation profiling. We identified one large deletion (~2.5 Mb) and seven likely pathogenic/pathogenic (LP/P) variants, including two in autosomal dominant genes relevant to the patients′ phenotypes and five in autosomal recessive genes consistent with carrier status. This included a likely pathogenic de novo splice‐disrupting variant in the chromatin remodelling gene ARID1B, validated by RNA sequencing. DNA methylation analysis revealed epigenetic differences between CHD and NDD patients, with CHD patients showing elevated biological age acceleration. Comparison with a reference cohort of 178 controls identified four probands with extreme methylation dysregulation, including the individual with the ARID1B variant. Overall, these findings highlight the diagnostic and mechanistic value of integrative multiomic profiling in paediatric developmental disease cohorts.
Jamie-Lee M Thompson, Yun-Kai Gao, Eri Iwasawa et al.· Human Mutation· 0 citations
AIM
To evaluate genetic testing practices (exome sequencing, commercial panel, and in-house genetic panels) from a large tertiary hospital for determining gaps, and to identify clinical associations with pathogenic genetic variants.
METHOD
This retrospective cohort study included patients (age < 18 years) from a neurology department for whom genetic testing was requested for neurological disorders, epilepsy, and movement disorders (2020-2023). Logistic regression was used to identify clinical features predictive of positive results. The clinical benefits of genetic testing were studied.
RESULTS
Three hundred and ninety patients underwent genetic testing by exome sequencing (n = 125), commercial panel (n = 143), in-house epilepsy (n = 78), and movement disorder (n = 44) gene panels. Exome sequencing had the highest pathogenic yield (n = 49, 39%), followed by epilepsy (n = 22, 28%), movement disorder (n = 11, 25%), and commercial (n = 22, 15%) panels. Variants of uncertain significance were highest in commercial (64%) and epilepsy (34%) panels. Among the exome sequencing cohort, the predominant clinical features were developmental delay (89%), intellectual disability (51%), and epilepsy (35%). Pathogenic variants in the exome sequencing cohort were more likely in patients with severe developmental delay (33%, p = 0.03) and hypotonia (39%, p = 0.05). There was significant utility of genetic testing in informing clinical decision making (49% of pathogenic variants in exome sequencing cohort).
INTEPRETATION
Exome sequencing outperforms gene panels in confirming genetic diagnoses in paediatric neurological disorders, and highlights the need for building local diagnostic genetic-testing resources.
Wafa Bani Uraba, Byoung Chan Lee, S. Mohammad et al.· Developmental Medicine & Chi...· 0 citations
