期刊
AMERICAN JOURNAL OF HUMAN GENETICS
卷 106, 期 2, 页码 272-279出版社
CELL PRESS
DOI: 10.1016/j.ajhg.2020.01.007
关键词
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资金
- Wellcome [200990]
- Basque Government [PRE_2018_1_0253]
- University of the Basque Country (UPV/EHU, PIF 2018)
- Carlos III Health Program [PI17/00380]
- Pais Vasco Department of Health [2018111043, 2018222031]
- UK Medical Research Council [MC_PC_13029]
- Israel Science Foundation [1663/17]
- National Institute of General Medical Sciences of the National Institutes of Health [5 P20 GM103636-07]
- US National Institute of Neurological Disorders and Stroke [R35NS105078]
- National Institute of General Medical Sciences [R01GM106373]
- National Human Genome Research Institute [UM1 HG006542]
- National Heart Lung and Blood Institute (NHGRI/NHBLI) [UM1 HG006542]
- Wellcome Centre for Mitochondrial Research [203105/Z/16/Z]
- Medical Research Council (MRC) International Centre for Genomic Medicine in Neuromuscular Disease, Mitochondrial Disease Patient Cohort (UK) [G0800674]
- UK NIHR Biomedical Research Centre for Aging and Age-related disease award
- MRC/EPSRC Molecular Pathology Node
- Lily Foundation
- UK NHS Highly Specialised Service for Rare Mitochondrial Disorders of Adults and Children
- Health Innovation Challenge Fund [HICF-1009-003]
- MRC [MC_PC_13029/2] Funding Source: UKRI
Recent studies have identified both recessive and dominant forms of mitochondrial disease that result from ATAD3A variants. The recessive form includes subjects with biallelic deletions mediated by non-allelic homologous recombination. We report five unrelated neonates with a lethal metabolic disorder characterized by cardiomyopathy, corneal opacities, encephalopathy, hypotonia, and seizures in whom a monoallelic reciprocal duplication at the ATAD3 locus was identified. Analysis of the breakpoint junction fragment indicated that these 67 kb heterozygous duplications were likely mediated by non-allelic homologous recombination at regions of high sequence identity in ATAD3A exon 11 and ATAD3C exon 7. At the recombinant junction, the duplication allele produces a fusion gene derived from ATAD3A and ATAD3C, the protein product of which lacks key functional residues. Analysis of fibroblasts derived from two affected individuals shows that the fusion gene product is expressed and stable. These cells display perturbed cholesterol and mitochondrial DNA organization similar to that observed for individuals with severe ATAD3A deficiency. We hypothesize that the fusion protein acts through a dominant-negative mechanism to cause this fatal mitochondrial disorder. Our data delineate a molecular diagnosis for this disorder, extend the clinical spectrum associated with structural variation at the ATAD3 locus, and identify a third mutational mechanism for ATAD3 gene cluster variants. These results further affirm structural variant mutagenesis mechanisms in sporadic disease traits, emphasize the importance of copy number analysis in molecular genomic diagnosis, and highlight some of the challenges of detecting and interpreting clinically relevant rare gene rearrangements from next-generation sequencing data.
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