Exome Sequencing Identifies Mutations in the Gene TTC7A In
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Developmental defects J Med Genet: first published as 10.1136/jmedgenet-2012-101483 on 19 February 2013. Downloaded from ORIGINAL ARTICLE Exome sequencing identifies mutations in the gene TTC7A in French-Canadian cases with hereditary multiple intestinal atresia Mark E Samuels,1 Jacek Majewski,2 Najmeh Alirezaie,2 Isabel Fernandez,1,3 Ferran Casals,1 Natalie Patey,1,4 Hélène Decaluwe,1,5 Isabelle Gosselin,6 Elie Haddad,1,3,5 Alan Hodgkinson,1 Youssef Idaghdour,1 Valerie Marchand,1,5 1,5 6,7 6 6 Open Access Jacques L Michaud, Marc-André Rodrigue, Sylvie Desjardins, Stéphane Dubois, Scan to access more 1,3 1,5 6,7 8 free content Francoise Le Deist, Philip Awadalla, Vincent Raymond, Bruno Maranda ▸ Additional material is ABSTRACT attempted, outcomes are poor and the condition is published online only. To view Background Congenital multiple intestinal atresia usual fatal within the first month of life. To date, please visit the journal online (http://dx.doi.org/10.1136/ (MIA) is a severe, fatal neonatal disorder, involving the no primary aetiology has been proved for the con- jmedgenet-2012-101483). occurrence of obstructions in the small and large dition. Importantly, in some cases MIA is also asso- 1 intestines ultimately leading to organ failure. Surgical ciated with either mild or severe combined Centre de Recherche du CHU fi 2–5 Ste-Justine, University of interventions are palliative but do not provide long-term immunode ciency (SCID), raising the possibility Montreal, Montreal, Quebec, survival. Severe immunodeficiency may be associated that an abnormal immune response might be the Canada with the phenotype. A genetic basis for MIA is likely. We origin of the disease. However failure of normal 2 Department of Human had previously ascertained a cohort of patients of embryogenesis remains a possibility with inflamma- Genetics, McGill University, Montreal, Quebec, Canada French-Canadian origin, most of whom were deceased tion or immune dysfunction only secondary. Most 3Department of Microbiology as infants or in utero. The goal of the study was to MIA cases are sporadic, although a genetic basis for and Immunology, University of identify the molecular basis for the disease in the congenital cases is likely given some familial recur- Montreal, Montreal, Quebec, patients of this cohort. rences.26A cluster of cases from Quebec, ascertained Canada 4 Methods We performed whole exome sequencing on by us, is also consistent with a genetic cause, given Department of Pathology, fi University of Montreal, samples from ve patients of four families. Validation of frequent documented French-Canadian founder Montreal, Quebec, Canada mutations and familial segregation was performed using effects going back to the first immigrants and leading 5Department of Pediatrics, standard Sanger sequencing in these and three to increased incidences of specific recessive disor- University of Montreal, additional families with deceased cases. Exon skipping ders.7 Other neonatal conditions involving local atre- Montreal, Quebec, Canada 6Department of Neurosciences, was assessed by reverse transcription-PCR and Sanger sias within the small or large intestine are also Centre de recherche du CHU sequencing. known, but it remains unclear whether these repre- http://jmg.bmj.com/ de Québec, Université Laval, Results Five patients from four different families were sent fundamentally different disease entities from Québec City, Quebec, Canada 7 each homozygous for a four base intronic deletion in the MIA or simply less severe examples. Département de Médecine gene TTC7A, immediately adjacent to a consensus GT Through whole exome sequencing of patients of Moléculaire, Université Laval, fi Québec City, Quebec, Canada splice donor site. The deletion was demonstrated to have French-Canadian origin, we identi ed two muta- 8Medical Genetics Service, deleterious effects on splicing causing the skipping of tions in a single gene, the tetratricopeptide repeat University of Sherbrooke, the attendant upstream coding exon, thereby leading to (TPR) domain 7A gene TTC7A, that could explain Sherbrooke, Quebec, Canada a predicted severe protein truncation. Parents were the disease in the affected cases. Mouse mutations on September 23, 2021 by guest. Protected copyright. Correspondence to heterozygous carriers of the deletion in these families in the orthologous gene are known and while the Bruno Maranda, and in two additional families segregating affected mice exhibit some abnormalities in their immune – Medical Genetics Service, cases. In a seventh family, an affected case was system, they lack a gastrointestinal phenotype.8 10 University of Sherbrooke, compound heterozygous for the same 4bp deletion and Sherbrooke, Quebec, Canada a second missense mutation p.L823P, also predicted as J1K 2R1; Bruno.Maranda@ METHODS USherbrooke.ca pathogenic. No other sequenced genes possessed Clinical ascertainment and patient descriptions deleterious variants explanatory for all patients in the In the course of clinical practice over many Received 14 December 2012 cohort. Neither mutation was seen in a large set of years, more than 20 patients with MIA have Accepted 22 January 2013 control chromosomes. been identified at the Centre Hospitalier de Published Online First ’ 19 February 2013 Conclusions Based on our genetic results, TTC7A is l Université Laval (CHUL) in Québec City, some the likely causal gene for MIA. previously described.2 All cases were reportedly of French-Canadian origin, though not formally related by known genealogy up to their great- INTRODUCTION grandparents. DNA suitable for genome-wide ana- Hereditary multiple intestinal atresia (MIA) (MIM lysis was obtained from these cases as well as three (243150)) is a severe congenital disorder, first for- newly ascertained cases. DNA from three add- fi 1 fi To cite: Samuels ME, mally de ned in 1973. MIA typically involves itional deceased cases was obtained from paraf n Majewski J, Alirezaie N, multiple lesions which occur at various levels blocks (F2, F4 and F5). We also had intestinal et al. J Med Genet throughout the small and large intestines.2 tissues embedded in plastic for two deceased cases – 2013;50:324 329. Although surgical intervention is sometimes (F3, F5) but DNA extracted from these blocks was 324 Samuels ME, et al. J Med Genet 2013;50:324–329. doi:10.1136/jmedgenet-2012-101483 Developmental defects J Med Genet: first published as 10.1136/jmedgenet-2012-101483 on 19 February 2013. Downloaded from degraded and could not be amplified. DNA from the sampled 100 bp paired end reads was carried out on Illumina HiSeq patient in F2 was also degraded. DNA for segregation studies 2000. Capture and sequencing was performed at the McGill was obtained for parents and/or unaffected siblings from all University and Genome Quebec Centre for Innovation. seven families (F1 to F7). Sequence reads were aligned to the human reference genome The three cases which underwent exome sequencing are hg19 using Burrows-Wheeler Alignment (BWA 0.5.9).11 described. The first case was born at term. The baby was imme- Genome Analysis Toolkit (GATK) was used for realignment diately brought to medical attention because of intestinal around suspected indels,12 and Picard was employed to mark obstruction and omphalocoele. He died the following day of duplicate reads and exclude them from downstream analyses.13 bowel obstruction. Autopsy revealed MIA. The second case is a Single nucleotide variants (SNVs) and short insertions and dele- fetus aborted at 23 weeks of gestation. Fetal ultrasound showed tions (indels) were called using Samtools mpileup.13 Mutations significant bowel distension at 22 weeks. Since the parents had a were annotated using Annovar14 and custom scripts. Filtering of child who died at 2 days of MIA the previous year, a recurrence common variants and recurrent technical artefacts of sequencing was highly suspected. Fetal autopsy showed MIA. The third case chemistry and/or read misalignment was performed using was born after a 35 weeks pregnancy, characterised by polyhy- dbSNP132, Exome Variant Server (EVS), the 1000 Genomes dramnios. Intestinal obstruction was suspected at birth on clin- variant dataset and a custom database of approximately 700 ical grounds. Imaging findings were consistent with a diagnosis exomes previously sequenced at our centre for unrelated pro- of MIA. Considering the invariably fatal outcome of this condi- jects. Variants seen in more than 20 control exomes, SNVs with tion in our centre, palliative care was given to the infant. a ratio of variant reads less than 0.2 and insertion/deletions with Autopsy was declined by the parents and the baby died at home a ratio of variant reads less than 0.15, were excluded from during the 1st week. further analysis. Only variants predicted to change protein Patients with MIA have also been identified at the Centre sequence (exonic non-synonymous SNVs, short indels, splice Hospitalier Ste-Justine (CHU Ste-Justine) in Montreal.1 In one site SNVs) were considered. Private variants were defined as family (F7) two newly ascertained male siblings (P11 and P14), those absent from dbSNP, 1000 Genomes, Exome Variant not previously described, were diagnosed with MIA. DNA was Server and our internal exome databases. Variants were visua- obtained from peripheral blood of one sibling, and from pre- lised using Integrative Genomics Viewer (IGV), or with served tissue of the other. The family is reportedly of NextGene (Soft Genetics, Inc.) French-Canadian origin on the maternal side, though not Sequences of primers for amplification and sequencing of known to be related to the CHUL and partial English ancestry TTC7A exons are given in online supplementary materials. on the paternal side. Genomic DNA was extracted using the Puregene DNA isolation The first sibling was born after 32 weeks of pregnancy compli- protocol from 28 ml of whole blood drawn by venipuncture. cated by polyhydramnios. Prenatal diagnosis of intestinal atresia PCRs were performed on a Hybaid Omnigene Temperature was highly suspected because bowel distension was observed on Cycling System in a total volume of 50 ml containing 100 ng of fetal ultrasound at 25 weeks of gestation.