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  • 1
    In: European Respiratory Journal, European Respiratory Society (ERS), Vol. 60, No. 5 ( 2022-11), p. 2200176-
    Abstract: Bronchiectasis can result from infectious, genetic, immunological and allergic causes. 60–80% of cases are idiopathic, but a well-recognised genetic cause is the motile ciliopathy, primary ciliary dyskinesia (PCD). Diagnosis of PCD has management implications including addressing comorbidities, implementing genetic and fertility counselling and future access to PCD-specific treatments. Diagnostic testing can be complex; however, PCD genetic testing is moving rapidly from research into clinical diagnostics and would confirm the cause of bronchiectasis. Methods This observational study used genetic data from severe bronchiectasis patients recruited to the UK 100,000 Genomes Project and patients referred for gene panel testing within a tertiary respiratory hospital. Patients referred for genetic testing due to clinical suspicion of PCD were excluded from both analyses. Data were accessed from the British Thoracic Society audit, to investigate whether motile ciliopathies are underdiagnosed in people with bronchiectasis in the UK. Results Pathogenic or likely pathogenic variants were identified in motile ciliopathy genes in 17 (12%) out of 142 individuals by whole-genome sequencing. Similarly, in a single centre with access to pathological diagnostic facilities, 5–10% of patients received a PCD diagnosis by gene panel, often linked to normal/inconclusive nasal nitric oxide and cilia functional test results. In 4898 audited patients with bronchiectasis, 〈 2% were tested for PCD and 〈 1% received genetic testing. Conclusions PCD is underdiagnosed as a cause of bronchiectasis. Increased uptake of genetic testing may help to identify bronchiectasis due to motile ciliopathies and ensure appropriate management.
    Type of Medium: Online Resource
    ISSN: 0903-1936 , 1399-3003
    Language: English
    Publisher: European Respiratory Society (ERS)
    Publication Date: 2022
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  • 2
    In: Science Advances, American Association for the Advancement of Science (AAAS), Vol. 9, No. 17 ( 2023-04-28)
    Abstract: Genes are identified that predispose to familial glioma, a rare, genetic and deadly disease.
    Type of Medium: Online Resource
    ISSN: 2375-2548
    Language: English
    Publisher: American Association for the Advancement of Science (AAAS)
    Publication Date: 2023
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  • 3
    In: npj Genomic Medicine, Springer Science and Business Media LLC, Vol. 7, No. 1 ( 2022-03-14)
    Abstract: Cardiomyopathy (CMP) is a heritable disorder. Over 50% of cases are gene-elusive on clinical gene panel testing. The contribution of variants in non-coding DNA elements that result in cryptic splicing and regulate gene expression has not been explored. We analyzed whole-genome sequencing (WGS) data in a discovery cohort of 209 pediatric CMP patients and 1953 independent replication genomes and exomes. We searched for protein-coding variants, and non-coding variants predicted to affect the function or expression of genes. Thirty-nine percent of cases harbored pathogenic coding variants in known CMP genes, and 5% harbored high-risk loss-of-function (LoF) variants in additional candidate CMP genes. Fifteen percent harbored high-risk regulatory variants in promoters and enhancers of CMP genes (odds ratio 2.25, p  = 6.70 × 10 −7 versus controls). Genes involved in α-dystroglycan glycosylation ( FKTN , DTNA ) and desmosomal signaling ( DSC2 , DSG2 ) were most highly enriched for regulatory variants (odds ratio 6.7–58.1). Functional effects were confirmed in patient myocardium and reporter assays in human cardiomyocytes, and in zebrafish CRISPR knockouts. We provide strong evidence for the genomic contribution of functionally active variants in new genes and in regulatory elements of known CMP genes to early onset CMP.
    Type of Medium: Online Resource
    ISSN: 2056-7944
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
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  • 4
    In: BMC Nephrology, Springer Science and Business Media LLC, Vol. 24, No. 1 ( 2023-08-28)
    Abstract: The majority of cases of Dent’s disease are caused by pathogenic variants in the CLCN5 gene, which encodes a voltage-gated chloride ion channel (ClC-5), resulting in proximal tubular dysfunction. We present three members of the same family and one unrelated paediatric patient with the same insertion-deletion CLCN5  variant. The identification of these patients and positive familial segregation led to the re-classification of this variant from one of unknown significance to one of likely pathogenicity. Case presentation A 41 year old male presented with end stage kidney failure, proteinuria and haematuria. Whole genome sequencing identified an insertion-deletion variant in CLCN5 , resulting in a missense change (c.1744_1745delinsAA p.(Ala582Lys)). His brother and nephew, who both exhibited renal impairment, haematuria, proteinuria, glycosuria and nephrocalcinosis, were found to have the same variant. In addition, genetic testing of an unrelated paediatric patient who presented with proteinuria and hypercalciuria, demonstrated the same variant. Conclusions The identification of this novel variant in four individuals with features of Dent’s disease, has led to the re-classification of the variant to one of likely pathogenicity. As a result, our patients and any future patients with the same variant can be offered a likely diagnosis, without the need for kidney biopsy, and their family members can be offered genetic screening.
    Type of Medium: Online Resource
    ISSN: 1471-2369
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
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  • 5
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 12, No. 1 ( 2022-02-17)
    Abstract: Alport syndrome is the commonest inherited kidney disease and nearly half the pathogenic variants in the COL4A3–COL4A5 genes that cause Alport syndrome result in Gly substitutions. This study examined the molecular characteristics of Gly substitutions that determine the severity of clinical features. Pathogenic COL4A5 variants affecting Gly in the Leiden Open Variation Database in males with X-linked Alport syndrome were correlated with age at kidney failure (n = 157) and hearing loss diagnosis (n = 80). Heterozygous pathogenic COL4A3 and COL4A4 variants affecting Gly (n = 304) in autosomal dominant Alport syndrome were correlated with the risk of haematuria in the UK 100,000 Genomes Project. Gly substitutions were stratified by exon location (1 to 20 or 21 to carboxyl terminus), being adjacent to a non-collagenous region (interruption or terminus), and the degree of instability caused by the replacement residue. Pathogenic COL4A5 variants that resulted in a Gly substitution with a highly destabilising residue reduced the median age at kidney failure by 7 years (p = 0.002), and age at hearing loss diagnosis by 21 years (p = 0.004). Substitutions adjacent to a non-collagenous region delayed kidney failure by 19 years (p = 0.014). Heterozygous pathogenic COL4A3 and COL4A4 variants that resulted in a Gly substitution with a highly destabilising residue (Arg, Val, Glu, Asp, Trp) were associated with an increased risk of haematuria (p = 0.018), and those adjacent to a non-collagenous region were associated with a reduced risk (p = 0.046). Exon location had no effect. In addition,  COL4A5 variants adjacent to non-collagenous regions were over-represented in the normal population in gnomAD (p  〈  0.001). The nature of the substitution and of nearby residues determine the risk of haematuria, early onset kidney failure and hearing loss for Gly substitutions in X-linked and autosomal dominant Alport syndrome.
    Type of Medium: Online Resource
    ISSN: 2045-2322
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
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  • 6
    In: Nature Cardiovascular Research, Springer Science and Business Media LLC, Vol. 1, No. 5 ( 2022-04-20), p. 529-531
    Type of Medium: Online Resource
    ISSN: 2731-0590
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
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  • 7
    In: Nature Cardiovascular Research, Springer Science and Business Media LLC, Vol. 1, No. 2 ( 2022-02-17), p. 157-173
    Abstract: Clinical presentation of congenital heart disease is heterogeneous, making identification of the disease-causing genes and their genetic pathways and mechanisms of action challenging. By using in vivo electrocardiography, transthoracic echocardiography and microcomputed tomography imaging to screen 3,894 single-gene-null mouse lines for structural and functional cardiac abnormalities, here we identify 705 lines with cardiac arrhythmia, myocardial hypertrophy and/or ventricular dilation. Among these 705 genes, 486 have not been previously associated with cardiac dysfunction in humans, and some of them represent variants of unknown relevance (VUR). Mice with mutations in Casz1 , Dnajc18 , Pde4dip , Rnf38 or Tmem161b genes show developmental cardiac structural abnormalities, with their human orthologs being categorized as VUR. Using UK Biobank data, we validate the importance of the DNAJC18 gene for cardiac homeostasis by showing that its loss of function is associated with altered left ventricular systolic function. Our results identify hundreds of previously unappreciated genes with potential function in congenital heart disease and suggest causal function of five VUR in congenital heart disease.
    Type of Medium: Online Resource
    ISSN: 2731-0590
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
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  • 8
    In: European Journal of Human Genetics, Springer Science and Business Media LLC, Vol. 30, No. 12 ( 2022-12), p. 1439-1443
    Abstract: An important fraction of patients with rare disorders remains with no clear genetic diagnostic, even after whole-exome or whole-genome sequencing, posing a difficulty in giving adequate treatment and genetic counseling. The analysis of genomic data in rare disorders mostly considers the presence of single gene variants in coding regions that follow a concrete monogenic mode of inheritance. A digenic inheritance, with variants in two functionally-related genes in the same individual, is a plausible alternative that might explain the genetic basis of the disease in some cases. In this case, digenic disease combinations should be absent or underrepresented in healthy individuals. We develop a framework to evaluate the significance of digenic combinations and test its statistical power in different scenarios. We suggest that this approach will be relevant with the advent of new sequencing efforts including hundreds of thousands of samples.
    Type of Medium: Online Resource
    ISSN: 1018-4813 , 1476-5438
    RVK:
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
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  • 9
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 12, No. 1 ( 2022-07-04)
    Abstract: X-linked Alport syndrome is a genetic kidney disease caused by pathogenic COL4A5 variants, but little is known of the consequences of missense variants affecting the NC1 domain of the corresponding collagen IV α5 chain. This study examined these variants in a normal (gnomAD) and other databases (LOVD, Clin Var and 100,000 Genomes Project) to determine their pathogenicity and clinical significance. Males with Cys substitutions in the collagen IV α5 NC1 domain reported in LOVD (n = 25) were examined for typical Alport features, including age at kidney failure. All NC1 variants in LOVD (n = 86) were then assessed for structural damage using an online computational tool, Missense3D. Variants in the ClinVar, gnomAD and 100,000 Genomes Project databases were also examined for structural effects. Predicted damage associated with NC1 substitutions was then correlated with the level of conservation of the affected residues. Cys substitutions in males were associated with the typical features of X-linked Alport syndrome, with a median age at kidney failure of 31 years. NC1 substitutions predicted to cause structural damage were overrepresented in LOVD ( p   〈  0.001), and those affecting Cys residues or ‘buried’ Gly residues were more common than expected (both p   〈  0.001). Most NC1 substitutions in gnomAD (88%) were predicted to be structurally-neutral. Substitutions affecting conserved residues resulted in more structural damage than those affecting non-conserved residues ( p   〈  0.001). Many pathogenic missense variants affecting the collagen IV α5 NC1 domain have their effect through molecular structural damage and 3D modelling is a useful tool in their assessment.
    Type of Medium: Online Resource
    ISSN: 2045-2322
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
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  • 10
    In: Science, American Association for the Advancement of Science (AAAS), Vol. 376, No. 6591 ( 2022-04-22)
    Abstract: Mutational signatures—imprints of DNA damage and repair processes that have been operative during tumorigenesis—provide insights into environmental and endogenous causes of each patient’s cancer. Cancer genome sequencing studies permit exploration of mutational signatures. We investigated a very large number of whole-genome–sequenced cancers of many tumor types, substantially more than in previous efforts, to comprehensively reinforce our understanding of mutational signatures. RATIONALE We present mutational signature analyses of 12,222 whole-genome–sequenced cancers collected prospectively via the UK National Health Service (NHS) for the 100,000 Genomes Project. We identified single-base substitution (SBS) and double-base substitution (DBS) signatures independently in each organ. Exploiting this unusually large cohort, we developed a method to enhance discrimination of common mutational processes from rare, lower-frequency mutagenic processes. We validated our findings by independently performing analyses with data from two publicly available cohorts: 3001 primary cancers from the International Cancer Genome Consortium (ICGC) and 3417 metastatic cancers from the Hartwig Medical Foundation. We produced a set of reference signatures by comparing and contrasting the independently derived tissue-specific signatures and performing clustering analysis to unite mutational signatures from different tissues that could be due to similar processes. We included additional quality control measures such as dimensionality reduction of mixed signatures and gathered evidence that could help elucidate mechanisms and etiologies such as transcriptional and replication strand bias, associations with somatic drivers, and germline predisposition mutations. We also investigated additional mutation context and examined past clinical and treatment histories when possible, to explore potential etiologies. RESULTS Each organ contained a limited number of common SBS signatures (typically between 5 and 10). The number of common signatures was independent of cohort size. By contrast, the number of rare signatures was dependent on sample size, as the likelihood of detecting a rare signature is a function of its population prevalence. The same biological process produced slightly different signatures in diverse tissues, reinforcing that mutational signatures are tissue specific. Across organs, we clustered all tissue-specific signatures to ascertain mutational processes that were equivalent but occurring in different tissues (i.e., reference signatures). We obtained 82 high-confidence SBS reference signatures and 27 high-confidence DBS reference signatures. We compared these with previously reported mutational signatures, revealing 40 and 18 previously unidentified SBS and DBS signatures, respectively. Because we are cognizant of increasing complexity in mutational signatures and want to enable general users, we developed an algorithm called Signature Fit Multi-Step (FitMS) that seeks signatures in new samples while taking advantage of our recent findings. In a first step, FitMS detects common, organ-specific signatures; in a second step, it determines whether an additional rare signature is also present. CONCLUSION Mutational signature analysis of 18,640 cancers, the largest cohort of whole-genome–sequenced samples to date, has required methodological advances, permitting knowledge expansion. We have identified many previously unreported signatures and established the concept of common and rare signatures. The FitMS algorithm has been designed to exploit these advances to aid users in accurately identifying mutational processes in new samples. Discovery and application of common and rare mutational signatures. Analysis of three large whole-genome–sequenced cancer cohorts revealed that per-organ common signatures are limited in number, whereas numbers of rare signatures increase with increasing cohort size. Reference signatures permit comparisons across organs and cohorts. Henceforth, a new algorithm, FitMS, which accounts for common and rare signatures, can be used to analyze new samples. GEL, Genomics England cohort.
    Type of Medium: Online Resource
    ISSN: 0036-8075 , 1095-9203
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    Language: English
    Publisher: American Association for the Advancement of Science (AAAS)
    Publication Date: 2022
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