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Exome Sequencing and the Management of Neurometabolic Disorders.

TitleExome Sequencing and the Management of Neurometabolic Disorders.
Publication TypeJournal Article
Year of Publication2016
AuthorsTarailo-Graovac, M., Shyr C., Ross C. J., Horvath G. A., Salvarinova R., Ye X. C., Zhang L-H., Bhavsar A. P., J Y Lee J., Drögemöller B. I., Abdelsayed M., Alfadhel M., Armstrong L., Baumgartner M. R., Burda P., Connolly M. B., Cameron J., Demos M., Dewan T., Dionne J., A Evans M., Friedman J. M., Garber I., Lewis S., Ling J., Mandal R., Mattman A., McKinnon M., Michoulas A., Metzger D., Ogunbayo O. A., Rakic B., Rozmus J., Ruben P., Sayson B., Santra S., Schultz K. R., Selby K., Shekel P., Sirrs S., Skrypnyk C., Superti-Furga A., Turvey S. E., Van Allen M. I., Wishart D., Wu J., Wu J., Zafeiriou D., Kluijtmans L., Wevers R. A., Eydoux P., Lehman A. M., Vallance H., Stockler-Ipsiroglu S., Sinclair G., Wasserman W. W., & van Karnebeek C. D.
JournalN Engl J Med
Volume374
Issue23
Pagination2246-55
Date Published2016 Jun 09
ISSN1533-4406
KeywordsAdolescent, Adult, Child, Child, Preschool, Exome, Female, Genetic Testing, Genotype, Humans, Infant, Intellectual Disability, Male, Metabolism, Inborn Errors, Phenotype, Sequence Analysis, DNA, Young Adult
Abstract

BACKGROUND: Whole-exome sequencing has transformed gene discovery and diagnosis in rare diseases. Translation into disease-modifying treatments is challenging, particularly for intellectual developmental disorder. However, the exception is inborn errors of metabolism, since many of these disorders are responsive to therapy that targets pathophysiological features at the molecular or cellular level.METHODS: To uncover the genetic basis of potentially treatable inborn errors of metabolism, we combined deep clinical phenotyping (the comprehensive characterization of the discrete components of a patient's clinical and biochemical phenotype) with whole-exome sequencing analysis through a semiautomated bioinformatics pipeline in consecutively enrolled patients with intellectual developmental disorder and unexplained metabolic phenotypes.RESULTS: We performed whole-exome sequencing on samples obtained from 47 probands. Of these patients, 6 were excluded, including 1 who withdrew from the study. The remaining 41 probands had been born to predominantly nonconsanguineous parents of European descent. In 37 probands, we identified variants in 2 genes newly implicated in disease, 9 candidate genes, 22 known genes with newly identified phenotypes, and 9 genes with expected phenotypes; in most of the genes, the variants were classified as either pathogenic or probably pathogenic. Complex phenotypes of patients in five families were explained by coexisting monogenic conditions. We obtained a diagnosis in 28 of 41 probands (68%) who were evaluated. A test of a targeted intervention was performed in 18 patients (44%).CONCLUSIONS: Deep phenotyping and whole-exome sequencing in 41 probands with intellectual developmental disorder and unexplained metabolic abnormalities led to a diagnosis in 68%, the identification of 11 candidate genes newly implicated in neurometabolic disease, and a change in treatment beyond genetic counseling in 44%. (Funded by BC Children's Hospital Foundation and others.).

DOI10.1056/NEJMoa1515792
Alternate JournalN. Engl. J. Med.
PubMed ID27276562
PubMed Central IDPMC4983272
Grant ListR01 GM115431 / GM / NIGMS NIH HHS / United States
301221 / / Canadian Institutes of Health Research / Canada
GM115431 / GM / NIGMS NIH HHS / United States
RG/12/14/29885 / / British Heart Foundation / United Kingdom

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