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2017 ; 23
(ä): 470-481
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Next-generation sequencing to solve complex inherited retinal dystrophy: A case
series of multiple genes contributing to disease in extended families
#MMPMID28761320
Jones KD
; Wheaton DK
; Bowne SJ
; Sullivan LS
; Birch DG
; Chen R
; Daiger SP
Mol Vis
2017[]; 23
(ä): 470-481
PMID28761320
show ga
PURPOSE: With recent availability of next-generation sequencing (NGS), it is
becoming more common to pursue disease-targeted panel testing rather than
traditional sequential gene-by-gene dideoxy sequencing. In this report, we
describe using NGS to identify multiple disease-causing mutations that contribute
concurrently or independently to retinal dystrophy in three relatively small
families. METHODS: Family members underwent comprehensive visual function
evaluations, and genetic counseling including a detailed family history. A
preliminary genetic inheritance pattern was assigned and updated as additional
family members were tested. Family 1 (FAM1) and Family 2 (FAM2) were clinically
diagnosed with retinitis pigmentosa (RP) and had a suspected autosomal dominant
pedigree with non-penetrance (n.p.). Family 3 (FAM3) consisted of a large family
with a diagnosis of RP and an overall dominant pedigree, but the proband had
phenotypically cone-rod dystrophy. Initial genetic analysis was performed on one
family member with traditional Sanger single gene sequencing and/or panel-based
testing, and ultimately, retinal gene-targeted NGS was required to identify the
underlying cause of disease for individuals within the three families. Results
obtained in these families necessitated further genetic and clinical testing of
additional family members to determine the complex genetic and phenotypic
etiology of each family. RESULTS: Genetic testing of FAM1 (n = 4 affected; 1
n.p.) identified a dominant mutation in RP1 (p.Arg677Ter) that was present for
two of the four affected individuals but absent in the proband and the presumed
non-penetrant individual. Retinal gene-targeted NGS in the fourth affected family
member revealed compound heterozygous mutations in USH2A (p. Cys419Phe,
p.Glu767Serfs*21). Genetic testing of FAM2 (n = 3 affected; 1 n.p.) identified
three retinal dystrophy genes (PRPH2, PRPF8, and USH2A) with disease-causing
mutations in varying combinations among the affected family members. Genetic
testing of FAM3 (n = 7 affected) identified a mutation in PRPH2 (p.Pro216Leu)
tracking with disease in six of the seven affected individuals. Additional
retinal gene-targeted NGS testing determined that the proband also harbored a
multiple exon deletion in the CRX gene likely accounting for her cone-rod
phenotype; her son harbored only the mutation in CRX, not the familial mutation
in PRPH2. CONCLUSIONS: Multiple genes contributing to the retinal dystrophy
genotypes within a family were discovered using retinal gene-targeted NGS.
Families with noted examples of phenotypic variation or apparent non-penetrant
individuals may offer a clue to suspect complex inheritance. Furthermore, this
finding underscores that caution should be taken when attributing a single gene
disease-causing mutation (or inheritance pattern) to a family as a whole.
Identification of a disease-causing mutation in a proband, even with a clear
inheritance pattern in hand, may not be sufficient for targeted, known mutation
analysis in other family members.