Truncating Biallelic Variant in DNAJA1, Encoding the Co-Chaperone Hsp40, Is Associated with Intellectual Disability and Seizures
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neurogenetics (2019) 20:109–115 https://doi.org/10.1007/s10048-019-00573-6 SHORT COMMUNICATION Truncating biallelic variant in DNAJA1, encoding the co-chaperone Hsp40, is associated with intellectual disability and seizures Saud Alsahli1,2 & Ahmed Alfares3,4 & Francisco J. Guzmán-Vega5 & Stefan T. Arold5 & Duaa Ba-Armah2,6 & Fuad Al Mutairi2,7 Received: 20 November 2018 /Accepted: 14 March 2019 /Published online: 10 April 2019 # Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Intellectual disability poses a huge burden on the health care system, and it is one of the most common referral reasons to the genetic and child neurology clinic. Intellectual disability (ID) is genetically heterogeneous, and it is associated with several other neurological conditions. Exome sequencing is a robust genetic tool and has revolutionized the process of molecular diagnosis and novel gene discovery. Besides its diagnostic clinical value, novel gene discovery is prime in reverse genetics, when human mutations help to understand the function of a gene and may aid in better understanding of the human brain and nervous system. Using WES, we identified a biallelic truncating variant in DNAJA1 gene (c.511C>T p.(Gln171*) in a multiplex Saudi consan- guineous family. The main phenotype shared between the siblings was intellectual disability and seizure disorder. Keywords Intellectual disability . Seizure disorder . DNAJA1 . Exome sequencing . Chaperonopathy . Chaperone . Co-chaperone . Hsp40 Introduction genetics is the most likely culprit in the majority of cases even when the child lacks syndromic or other systemic features [2]. Intellectual disability (ID) is a neurodevelopmental disorder that Comparative genomic hybridization (CGH) is considered now is defined as an impairment in intellectual and adaptive func- the first-tier diagnostic test to order; nevertheless with the intro- tioning [1]. ID is a relatively common medical condition affect- duction of next-generation sequencing (NGS), many now are ing at least 1% of the general population, and it can result from advocating exome sequencing (WES) as the first-tier test [3]. myriad of causes [2]. ID can be generally classified based on WEShasshowntobecost-effectiveandledtoashorterdiag- other associated systemic findings as syndromic and nonsyn- nostic interval [4]. The diagnostic yield of NGS in CGH nega- dromic. ID is genetically heterogeneous, and the level of genet- tive syndromic and nonsyndromic ID has been reported as 68 ic involvement in ID has not thus far been elucidated; however, and 50%, respectively [2]. Several studies have demonstrated a Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10048-019-00573-6) contains supplementary material, which is available to authorized users. * Fuad Al Mutairi 4 Department of Pediatrics, Qassim University, Almulyda, [email protected] Buraydah, Saudi Arabia 5 Division of Biological and Environmental Sciences and Engineering 1 ’ Department of Pediatric Neurology, Texas Children s Hospital, (BESE), King Abdullah University of Science and Technology Baylor College of Medicine, Houston, TX, USA (KAUST), Computational Bioscience Research Center (CBRC), Thuwal 23955-6900, Saudi Arabia 2 King Abdullah International Medical Research Center (KAIMRC), 6 College of Medicine, King Saud bin Abdulaziz University for Health Department of Pediatrics, King Abdulaziz Medical City, Division of Sciences, Riyadh, Saudi Arabia Pediatric Neurology, Ministry of National Guard-Health Affairs (MNGHA), Riyadh, Saudi Arabia 3 Department of Pathology and Laboratory Medicine, King Abdulaziz 7 Division of Genetics, Department of Pediatrics, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs (MNGHA), Medical City, Ministry of National Guard-Health Affairs (MNGHA), Riyadh, Saudi Arabia Riyadh, Saudi Arabia 110 Neurogenetics (2019) 20:109–115 Fig. 1 Family pedigree of the current cohort high diagnostic yield in sequencing inbred populations that maturation and maintenance, and finally targeting of proteins reachedupto50%[2, 5–7]. More importantly, NGS has accel- for degradation through proteolytic processes of client pro- erated the process of novel gene discovery or candidate gene teins [11]. Herein, we show that a biallelic truncating variant proposal, and it led to an unprecedented expansion in the num- in DNAJA1 gene may cause ID and seizures in humans. berofgeneslinkedtoIDwithanestimatedmorethan2500 genes thus far [8]. Gene hunting in inbred populations is easier due to autozygosity mapping in multiplex families, which nar- Human subjects and method rows the field of search and ending a journey of diagnostic odyssey. Reaching for an accurate diagnosis is particularly im- Human subjects portant for inbred populations where autosomal recessive foun- der mutations make a relatively large fraction of the molecular Three siblings from a Saudi consanguineous family presented pool, and perhaps a preventable cause of ID and other to our practice. Their parents are a first-degree consanguine- neurodevelopmental disorders [9, 10]. ous couple with five healthy children (Fig. 1). All the affected DNAJA1 gene encodes a member of the DNAJ family of siblings underwent a clinical evaluation by neurologists and proteins, also known as heat shock protein 40 (Hsp40 or clinical geneticists. Our institution’s standardized clinical ex- Hsc40), which acts as co-chaperone for Hsp70 and Hsp90. ome consent was obtained from their parents, and the study DNAJ proteins are responsible for several essential cellular received ethical approval from King Abdullah International processes including folding polypeptide chains, modulate pro- Medical Research Center (KAIMRC). Additional informed tein assembly, disassembly, translocation through membranes consent was obtained from all individual participants for into cellular compartments, assist in conformational whom identifying information is included in this article. Neurogenetics (2019) 20:109–115 111 Table 1 Current cohort phenotype Patient 1 Patient 2 Patient 3 Age 14 years 16 years 25 years Onset of the symptoms 3 months as seizure 12 months as DD Early childhood as DD Seizures + + + Seizures age of onset 3 months 11 years 12 years Intellectual disability + + + Behavioral disorders – + – Dysmorphic features + + + • Round face + + + • Protruding ears + + + • Short neck + + + • Concave nail beds ++ + + + + BMI 29.2 44.7 38.1 Brain MRI Thickened corpus callosum NA Normal EEG Normal NA Normal Other findings Renal stone Gallbladder stone Cleft palate Deviated nasal septum and otitis media DD developmental delay, BMI body mass index, MRI magnetic resonance imaging, EEG electroencephalography, NA not available Molecular analysis Results Autozygome analysis The three affected siblings share a strikingly similar pheno- type, and they look phenotypically different from their unaf- Blood samples were collected from all affected individuals, the fected siblings. All of them are overweight, intellectually dis- parents, and two healthy siblings in EDTA tubes, and DNA was abled with a generalized tonic clonic seizure disorder, have extracted from whole blood. We started with whole-genome ar- moon facies, protruding ears, and short neck. Epilepsy gene ray-based comparative genomic hybridization (aCGH) and panel was negative (Table 1) (Fig. 3) (see Table S2 for a genome-wide single nucleotide polymorphism (SNP) for the af- detailed clinical synopsis). fected siblings and their parents as previously described [12]. We Initial filtering for intellectual disability and seizure disor- did not detect any significant copy number changes; however, it der variants revealed no mutations. All the affected siblings showed large regions of homozygosity between the affected sib- were homozygous for a truncating variant in DNAJA1 gene lings and their parents (Table S1). (NM_001539.3) c.511C>T p.(Gln171*)). We confirmed the variant by Sanger sequencing in all patients, and the variant segregated well in unaffected family members (Fig. 2). This Exome sequencing variant was absent as well as other truncating variants in a large-scale exome sequencing databases such as Exome We then proceeded with WES in all affected patients and their Aggregation Consortium (ExAC), dbSNP/1000 genome, or parents as previously described [13]. The generated library is Exome Sequencing Project (ESP) and in the Genome sequenced on an Illumina platform to obtain an average coverage Aggregation Database (gnomAD) databases. Also, this vari- depth of ~ 100×. Typically, ~ 97% of the targeted bases are cov- ant along with other truncating variants were absent from ered > 10×. An end-to-end in-house bioinformatic pipeline in- 2000 ethnically matched controls in local database and our cluding base calling, alignment of reads to GRCh37/hg19 ge- institute’s database Majeen (1200 exomes). nome assembly, primary filtering out of low-quality reads and probable artifacts, and subsequent annotation of variants was applied. Evaluation is focused on coding exons along with Structural and functional analysis flanking ± 20 intronic bases. All inheritance patterns were con- sidered. In addition, provided family history and clinical infor- DNAJA1 is composed of a N-terminal J-domain followed by mation were used to evaluate eventually identified variants. a G/F-rich region and two zinc finger motifs, which connect to 112 Neurogenetics (2019) 20:109–115 227 of the 397 protein residues. This truncation results in the loss of two of the CXXCXGXG