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AB093. Report of a SMARCA4 variant identified in a patient with Coffin-Siris syndrome

ABSTRACT: Background Coffin-Siris syndrome (CSS, OMIM 614609) is a rare condition that affects multiple body systems. Hallmarks of this condition include developmental disability, abnormalities of the fifth fingers or toes, and characteristic facial features. Here, the case of a 4-year-old Chinese boy with lateral flaring and thick eyebrows, long eyelashes, coarse facies, left single palmar crease, absent of both fifth toenails, posterior cleft palate, umbilical hernia and congenital nystagmus is presented. The boy also has bilateral developmental dysplasia of the hip, which has not been reported in CSS. Methods Genomic DNA was extracted from peripheral blood samples collected from the patient and parents. Targeted next generation sequencing of the patient sample was performed on the Illumina MiSeq system using the TruSight One panel that covers >4,800 clinically relevant genes. Alignment and variant calling was carried out using the on-instrument MiSeq Reporter software, and the VCF file generated was annotated and filtered using WANNOVAR. The presence of the variant and the de novo status was confirmed by Sanger sequencing of patient and parental samples. Results A heterozygous c.3127C>T variant was detected in exon 23 of the SMARCA4 gene in the patient. It was not present in his parents. The de novo variant is predicted to cause a p. (Arg1043Trp) missense substitution of a highly conserved amino acid in the SNF2-related domain of the SMARCA4 protein, and can be classified as likely pathogenic for CSS based on the ACMG/AMP 2015 guidelines. This variant is not in the Exome Sequencing Project, 1000 Genomes Project and Exome Aggregation Consortium databases, although it has been reported previously in a patient with CSS. Conclusions The SMARCA4 gene encodes the ATP-hydroxylase containing subunits of the BAF complex and variants are expected to influence the ATP-hydrolase activity and affect downstream processes such as DNA packaging and gene expression.

SUBMITTER: Loke M

PROVIDER: S-EPMC5641751 | biostudies-literature | 2017 Sep

REPOSITORIES: biostudies-literature

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Project description:SMARCA4 chromatin remodelling factor is mutated in 11% of Coffin-Siris syndrome (CSS) patients and in almost all small-cell carcinoma of the ovary hypercalcaemic type (SCCOHT) tumours. Missense mutations with gain-of-function or dominant-negative effects are associated with CSS, whereas inactivating mutations, leading to loss of SMARCA4 expression, have been exclusively found in SCCOHT. We applied whole-exome sequencing to study a 15-year-old patient with mild CSS who concomitantly developed SCCOHT at age 13?years. Interestingly, our patient also showed congenital microphthalmia, which has never previously been reported in CSS patients. We detected a de novo germline heterozygous nonsense mutation in exon 19 of SMARCA4 (c.2935C?>?T;p.Arg979*), and a somatic frameshift mutation in exon 6 (c.1236_1236delC;p.Gln413Argfs*88), causing complete loss of SMARCA4 immunostaining in the tumour. The immunohistochemical findings are supported by the observation that the c.2935C?>?T mutant transcript was detected by reverse transcription polymerase chain reaction at a much lower level than the wild-type allele in whole blood and the lymphoblastoid cell line of the proband, confirming nonsense-mediated mRNA decay. Accordingly, immunoblotting demonstrated that there was approximately half the amount of SMARCA4 protein in the proband's cells as in controls. This study suggests that SMARCA4 constitutional mutations associated with CSS are not necessarily non-truncating, and that haploinsufficiency may explain milder CSS phenotypes, as previously reported for haploinsufficient ARID1B. In addition, our case supports the dual role of chromatin remodellers in developmental disorders and cancer, as well as the involvement of SMARCA4 in microphthalmia, confirming previous findings in mouse models and the DECIPHER database. Finally, we speculate that mild CSS might be under-recognized in a proportion of SCCOHT patients harbouring SMARCA4 mutations. © 2017 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.

Project description:BackgroundSevere congenital ophthalmological malformations and glaucoma might be an important occasional feature in patients with Coffin-Siris syndrome (CSS), especially Coffin-Siris syndrome 9 (CSS9, OMIM #615866) caused by SOX11 mutation. Recently, primary (open-angle) glaucoma was described in two children with the most common form of Coffin-Siris syndrome, CSS1 (OMIM #135900) by ARID1B (AT-rich interaction domain-containing protein 1B) gene mutation. In this article, we present the first report of glaucoma with Coffin-Siris syndrome 9 as well as the first report of secondary glaucoma with any form of Coffin-Siris syndrome. These findings indicate that secondary glaucoma is an occasional finding in patients with Coffin-Siris syndrome.Case presentationA child with secondary childhood glaucoma and additional ocular manifestations was evaluated and treated at the childhood glaucoma centre in Mainz, Germany. Examination under general anaesthesia revealed ocular anterior segment dysgenesis (ASD) (Peters type iridocorneal dysgenesis) in combination with congenital limbal stem cell deficiency (LSCD), aniridia, and cataract. The patient also had multiple other congenital anomalies and severe developmental delay. To explain his combination of anomalies, molecular genetic analysis from peripheral blood was performed in late 2018 and early 2019. Following normal findings with a panel diagnostic of 18 genes associated with congenital glaucoma, whole exome sequencing was performed and revealed a novel likely pathogenic heterozygous variant c.251G>T, p.(Gly84Val) in the SOX11 gene (SRY-related HMG-box gene 11). The variant had occurred de novo. Thus, the multiple congenital anomalies and developmental delay of the patient represented Coffin-Siris syndrome 9 (CSS9, OMIM #615866).ConclusionsWhen eye diseases occur in combination with other systemic features, genetic analysis can be seminal. Results indicate that glaucoma is an occasional feature of patients with Coffin-Siris syndrome. As early treatment may improve the visual outcome of patients with glaucoma, we suggest that patients with Coffin-Siris syndrome should receive specific ophthalmological screening.

Dataset Information

AB093. Report of a SMARCA4 variant identified in a patient with Coffin-Siris syndrome

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