First Report of Two Successive Deletions on Chromosome 15Q13
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Alsagob et al. Molecular Cytogenetics (2019) 12:21 https://doi.org/10.1186/s13039-019-0432-6 SHORTREPORT Open Access First report of two successive deletions on chromosome 15q13 cytogenetic bands in a boy and girl: additional data to 15q13.3 syndrome with a report of high IQ patient Maysoon Alsagob1, Mustafa A. Salih2, Muddathir H. A. Hamad2, Yusra Al-Yafee1, Jawaher Al-Zahrani1, Albandary Al-Bakheet1, Michael Nester3, Nadia Sakati3, Salma M. Wakil1, Ali AlOdaib1, Dilek Colak4 and Namik Kaya1,2* Abstract 15q13.3 syndrome is associated with a wide spectrum of neurological disorders. Among a cohort of 150 neurodevelopmental cases, we identified two patients with two close proximity interstitial hemizygous deletions on chromosome 15q13. Using high-density microarrays, we characterized these deletions and their approximate breakpoints. The second deletion in both patients overlaps in a small area containing CHRNA7 where the gene is partially deleted. The CHRNA7 is considered a strong candidate for the 15q13.3 deletion syndrome’s pathogenicity. Patient 1 has cognitive impairment, learning disabilities, hyperactivity and subtle dysmorphic features whereas patient 2 has mild language impairment with speech difficulty, mild dysmorphia, heart defect and interestingly a high IQ that has not been reported in 15q13.3 syndrome patients before. Our study presents first report of such two successive deletions in 15q13.3 syndrome patients and a high IQ in a 15q13.3 syndrome patient. Our study expands the breakpoints and phenotypic features related to 15q13.3 syndrome. Keywords: 15q13.3 syndrome, Consecutive deletions, High IQ, CHRNA7, Hyperactivity, Cognitive impairment, And learning disability Background psychiatric problems, such as schizophrenia and epilepsy 15q13.3 microdeletion syndrome (MS) expands on ap- with recurring seizures or in some cases asymptomatic proximately 1.5 Mbp on chromosome 15q. This region [3–8]. 15q13.3 MS may appear as de novo or could be is also known to involve in other diseases such as Prader transmitted in an autosomal dominant mode with re- Willi, Angelman syndrome, and autism [1, 2]. The syn- duced penetrance. Presence of homozygous microdele- drome has a wide spectrum of phenotypic consequences tions have also been reported [9, 10]. The prevalence of even within the same family. Patients exhibit various de- the disease remains unknown [1, 10–16]. However, a re- grees of intellectual disabilities ranging from rarely nor- cent study estimated that 1 in 5525 live birth has a mal intelligence to a high degree of impairment that pathogenic 15q13.3 microdeletion, which can indicates leads to severe learning difficulties. The condition may that the syndrome is under-diagnosed [17]. include various dysmorphic characteristics, neurodeve- In this study, a pool of 150 cases suspected to have lopmental phenotypes, impaired vision as well as chromosomal abnormalities, including dysmorphia, aut- ism, language delay, ADHD, speech and developmental * Correspondence: [email protected]; [email protected] delay, were examined. The investigation was carried out 1Department of Genetics, King Faisal Specialist Hospital and Research Centre, by different types of oligonucleotide microarrays. Among MBC: 03, Riyadh 11211, Kingdom of Saudi Arabia the cohort, two cases related to 15q13.3 deletion syn- 2Division of Pediatric Neurology, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia drome were identified. Both patients have consecutive Full list of author information is available at the end of the article microdeletions separated by an intact region in the © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Alsagob et al. Molecular Cytogenetics (2019) 12:21 Page 2 of 6 15q13 cytogenetic bands where CHRNA7 is partially with some help but could dress and feed herself without deleted. help. She was quite irritable and demanding, particularly with her parents, but not aggressive. At the age of 6 Clinical presentation years, she had an echocardiogram that showed a Patient 1 The patient is an 8 ½ -year-old boy presented redundant mildly prolapsed mitral valve. The cardiac with hyperactivity, cognitive impairment, learning dis- muscle was mildly thickened, but otherwise normal in abilities and subtle dysmorphic features. He was born at function. At the age of 7 years she was evaluated by a term to non-consanguineous parents. Pregnancy history neurophysiologist due to speech delay and diagnosed was not remarkable and there were no postnatal compli- with expressive language delay but normal psychomotor cations. He was said to be floppy initially, but managed development. Her weight was only 15.3 kg, which is far to sit by the age of 8 months, and walked by his 15th below the 5th percentile; and her height was 104.5 cm, month. Additionally, language abilities are significantly which is also far below 5th percentile. The second ECG delayed and he is currently able to say comprehensible was also performed confirming previous findings of lo- sentences of 3–4 words only. He was also noted to be calized septal hypertrophy and redundant anterior mitral hyperactive with stereotypic hands movements which leaflet. At the age of 16 she has a short status found to improved significantly after some sessions of behavioral have growth hormone deficiency and delayed puberty. therapy. His parents noted improvement in his social Molecular analysis of the patient 1 was done using skills after he was on methylphenidate hydrochloride high-resolution GTW-banding and high-density oligo with a dose of 36 mg once daily 2 years ago. His IQ was arrays. High-resolution GTW-banding (550 band reso- graded as 70 at the age of 6 years and was attending a lution) was carried out as part of diagnostic procedures special needs school. Upon examination, his weight was and did not reveal any gross abnormality. Cytoscan HD 21 kg at the 5th centile, height was 126.6 cm (> 25th arrays (Affymetrix Inc., San Paolo, CA, US) identified <50th centile) and his head circumference was 53 cm two deletions with close proximity on 15q13 cytogenetic. (slightly above the 50th centile). He showed subtle dys- The second deletion sits on 15q13.3 band (Table 1, morphic features with large ears, prominent nasal tip, Fig. 1a). The deletion sites are covered by more than clinodactyly of the fifth finger and persistent fetal finger- 1082 probes in the first and 1052 probes in the second tip pads. There was one tiny pigmented naevus on the deletions. There are probeless regions on both deletions left cheek and another two (about 0.5 cm) over the abdo- making precise BP calculations difficult. Interestingly, an men and back. Cranial nerves were intact and he had area covered by 435 SNP-CP probes between the dele- normal tone, power and reflexes in the upper and the tions clearly demonstrated that these deletions are two lower limbs with normal gait. separate unique deletions in the region (Fig. 1a). Parental Patient 2 The patient is a 17-year-old female who has DNA was tested using the same chip, no chromosomal been followed up at King Faisal Specialist Hospital and imbalance was detected hence the hemizygous deletion Research Center (KFSHRC) for nearly 15 years. The pa- in our patient is considered de novo. tient was referred to KFSHRC with the suspicion of aut- Patient 2 was also analyzed using GTW-banding that ism and had history of speech and language delay. She did not revealed any abnormality. However, similar to had normal pre- and perinatal history with slow mile- patient 1, SNP Array 6.0 (Affymetrix Inc.) indicated two stones in language areas. She was given Beery-VMI, Lei- consecutive deletions on 15q13. The first deletion is ter International Performance Scale, Selected subtests, located on 15q13.2 while the second deletion resides on and McCarthy Scales of Children’s Abilities (MSCA) at 15q13.3 (Table 1, Fig. 1b). During the analyses, we the age of 4-year-2-month-old. She managed a 3 and 5 converted hg18 annotations to hg19 using UCSC’s Left block figures on MSCA without difficulty for an equiva- Genome Annotations application for the purpose of lency of 4+ years. She stacked only six blocks, showed comparison (Fig. 1c). The coordinates after the conversion some motor clumsiness. She speaks full sentences with are 30,450,356–30,779,579 (hg19) and 32,561,665– reasonable clarity but her vocabulary was limited. She 32,876,972 (hg19) for the first and the second deletion, re- named only one of the picture vocabulary cards and was spectively. The first deletion is pointed out by 95 CN and able to point 17 out of 19. She follows directions and 2 SNP probes on 6.0 arrays whereas the second deletion is her receptive language skills seem relatively impact. She covered by only 43 CN probes on the same arrays. The did extremely well on the Leiter with an age equivalency parental DNA was not available for examination. of 5-years-5-months-old and IQ of 134. On the Beery-VMI she had similar but little lesser score. She Discussion and conclusions showed poor pencil control with an age of equivalency Six break points (BPs) have been characterized in 15q of 42 months and a standard score of 93. There were no region, due to the prevalence of low-copy repeats in attention related problems.