Comprehensive genotyping and clinical characterisation reveal 27 novel NKX2-1 mutations and expand the phenotypic spectrum.

Abstract

BACKGROUND:

NKX2-1 encodes a transcription factor with large impact on the development of brain, lung and thyroid. Germline mutations of NKX2-1 can lead to dysfunction and malformations of these organs. Starting from the largest coherent collection of patients with a suspected phenotype to date, we systematically evaluated frequency, quality and spectrum of phenotypic consequences of NKX2-1 mutations.

METHODS:

After identifying mutations by Sanger sequencing and array CGH, we comprehensively reanalysed the phenotype of affected patients and their relatives. We employed electrophoretic mobility shift assay (EMSA) to detect alterations of NKX2-1 DNA binding. Gene expression was monitored by means of in situ hybridisation and compared with the expression level of MBIP, a candidate gene presumably involved in the disorders and closely located in close genomic proximity to NKX2-1.

RESULTS:

Within 101 index patients, we detected 17 point mutations and 10 deletions. Neurological symptoms were the most consistent finding (100%), followed by lung affection (78%) and thyroidal dysfunction (75%). Novel symptoms associated with NKX2-1 mutations comprise abnormal height, bouts of fever and cardiac septum defects. In contrast to previous reports, our data suggest that missense mutations in the homeodomain of NKX2-1 not necessarily modify its DNA binding capacity and that this specific type of mutations may be associated with mild pulmonary phenotypes such as asthma. Two deletions did not include NKX2-1, but MBIP, whose expression spatially and temporarily coincides with NKX2-1 in early murine development.

CONCLUSIONS:

The high incidence of NKX2-1 mutations strongly recommends the routine screen for mutations in patients with corresponding symptoms. However, this analysis should not be confined to the exonic sequence alone, but should take advantage of affordable NGS technology to expand the target to adjacent regulatory sequences and the NKX2-1 interactome in order to maximise the yield of this diagnostic effort.

• Authors: Anne Thorwarth, Sarah Schnittert-Hübener, Pamela Schrumpf, Ines Müller, Sabine Jyrch, Christof Dame, Heike Biebermann, Gunnar Kleinau, Juri Katchanov, Markus Schuelke, Grit Ebert, Anne Steininger, Carsten Bönnemann, Knut Brockmann, Hans-Jürgen Christen, Patricia Crock, Francis deZegher, Matthias Griese, Jacqueline Hewitt, Sten Ivarsson, Christoph Hübner, Klaus Kapelari, Barbara Plecko, Dietz Rating, Iva Stoeva, Hans-Hilger Ropers, Annette Grüters, Reinhard Ullmann, Heiko Krude
• Journal: Journal of medical genetics (J Med Genet) Vol. 51 Issue 6 Pg. 375-87 (Jun 2014) ISSN: 1468-6244 [Electronic] England
• PMID: 24714694 (Publication Type: Journal Article)
• Copyright: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Chemical References

• Nuclear Proteins
• Thyroid Nuclear Factor 1
• Transcription Factors

Topics

• Adolescent
• Child
• Child, Preschool
• Comparative Genomic Hybridization
• DNA Copy Number Variations (genetics)
• Electrophoretic Mobility Shift Assay
• Female
• Gene Deletion
• Genetic Diseases, Inborn (genetics, physiopathology)
• Humans
• Infant
• Infant, Newborn
• Male
• Nuclear Proteins (genetics)
• Phenotype
• Point Mutation (genetics)
• Thyroid Nuclear Factor 1
• Transcription Factors (genetics)