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2016 ; 11
(9
): e0161802
Nephropedia Template TP
gab.com Text
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English Wikipedia
X-Linked and Autosomal Recessive Alport Syndrome: Pathogenic Variant Features and
Further Genotype-Phenotype Correlations
#MMPMID27627812
Savige J
; Storey H
; Il Cheong H
; Gyung Kang H
; Park E
; Hilbert P
; Persikov A
; Torres-Fernandez C
; Ars E
; Torra R
; Hertz JM
; Thomassen M
; Shagam L
; Wang D
; Wang Y
; Flinter F
; Nagel M
PLoS One
2016[]; 11
(9
): e0161802
PMID27627812
show ga
Alport syndrome results from mutations in the COL4A5 (X-linked) or COL4A3/COL4A4
(recessive) genes. This study examined 754 previously- unpublished variants in
these genes from individuals referred for genetic testing in 12 accredited
diagnostic laboratories worldwide, in addition to all published COL4A5, COL4A3
and COL4A4 variants in the LOVD databases. It also determined genotype-phenotype
correlations for variants where clinical data were available. Individuals were
referred for genetic testing where Alport syndrome was suspected clinically or on
biopsy (renal failure, hearing loss, retinopathy, lamellated glomerular basement
membrane), variant pathogenicity was assessed using currently-accepted criteria,
and variants were examined for gene location, and age at renal failure onset.
Results were compared using Fisher's exact test (DNA Stata). Altogether 754 new
DNA variants were identified, an increase of 25%, predominantly in people of
European background. Of the 1168 COL4A5 variants, 504 (43%) were missense
mutations, 273 (23%) splicing variants, 73 (6%) nonsense mutations, 169 (14%)
short deletions and 76 (7%) complex or large deletions. Only 135 of the 432 Gly
residues in the collagenous sequence were substituted (31%), which means that
fewer than 10% of all possible variants have been identified. Both missense and
nonsense mutations in COL4A5 were not randomly distributed but more common at the
70 CpG sequences (p<10-41 and p<0.001 respectively). Gly>Ala substitutions were
underrepresented in all three genes (p< 0.0001) probably because of an
association with a milder phenotype. The average age at end-stage renal failure
was the same for all mutations in COL4A5 (24.4 ±7.8 years), COL4A3 (23.3 ± 9.3)
and COL4A4 (25.4 ± 10.3) (COL4A5 and COL4A3, p = 0.45; COL4A5 and COL4A4, p =
0.55; COL4A3 and COL4A4, p = 0.41). For COL4A5, renal failure occurred sooner
with non-missense than missense variants (p<0.01). For the COL4A3 and COL4A4
genes, age at renal failure occurred sooner with two non-missense variants (p =
0.08, and p = 0.01 respectively). Thus DNA variant characteristics that predict
age at renal failure appeared to be the same for all three Alport genes. Founder
mutations (with the pathogenic variant in at least 5 apparently- unrelated
individuals) were not necessarily associated with a milder phenotype. This study
illustrates the benefits when routine diagnostic laboratories share and analyse
their data.
|Adult
[MESH]
|Age of Onset
[MESH]
|Alternative Splicing/genetics
[MESH]
|Autoantigens/genetics
[MESH]
|Codon, Nonsense/genetics
[MESH]
|Collagen Type IV/genetics
[MESH]
|Female
[MESH]
|Gene Deletion
[MESH]
|Genetic Association Studies/statistics & numerical data
[MESH]