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The American Journal of Human Genetics
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De Novo and Inherited Loss-of-Function Variants in TLK2: Clinical and Genotype-Phenotype Evaluation of a Distinct Neurodevelopmental Disorder

Clinical and Genotype-Phenotype Evaluation of a Distinct Neurodevelopmental Disorder
Authors: Reijnders, Margot RF; Miller, Kerry A; Alvi, Mohsan; Goos, Jacqueline AC; Lees, Melissa M; de Burca, Anna; Henderson, Alex; +63 Authors

De Novo and Inherited Loss-of-Function Variants in TLK2: Clinical and Genotype-Phenotype Evaluation of a Distinct Neurodevelopmental Disorder

Abstract

Next-generation sequencing is a powerful tool for the discovery of genes related to neurodevelopmental disorders (NDDs). Here, we report the identification of a distinct syndrome due to de novo or inherited heterozygous mutations in Tousled-like kinase 2 (TLK2) in 38 unrelated individuals and two affected mothers, using whole-exome and whole-genome sequencing technologies, matchmaker databases, and international collaborations. Affected individuals had a consistent phenotype, characterized by mild-borderline neurodevelopmental delay (86%), behavioral disorders (68%), severe gastro-intestinal problems (63%), and facial dysmorphism including blepharophimosis (82%), telecanthus (74%), prominent nasal bridge (68%), broad nasal tip (66%), thin vermilion of the upper lip (62%), and upslanting palpebral fissures (55%). Analysis of cell lines from three affected individuals showed that mutations act through a loss-of-function mechanism in at least two case subjects. Genotype-phenotype analysis and comparison of computationally modeled faces showed that phenotypes of these and other individuals with loss-of-function variants significantly overlapped with phenotypes of individuals with other variant types (missense and C-terminal truncating). This suggests that haploinsufficiency of TLK2 is the most likely underlying disease mechanism, leading to a consistent neurodevelopmental phenotype. This work illustrates the power of international data sharing, by the identification of 40 individuals from 26 different centers in 7 different countries, allowing the identification, clinical delineation, and genotype-phenotype evaluation of a distinct NDD caused by mutations in TLK2.

Keywords

Tousled-like ; Facial Averaging ; Haploinsufficiency ; Intellectual Disability ; Kinase, Male, Kinase, Biomedical and clinical sciences, Messenger, Intellectual disability, Medizin, Inheritance Patterns, Haploinsufficiency, Protein Kinases/genetics, Neurodevelopmental Disorders/genetics, Medical and Health Sciences, Translocation, Genetic, Loss of Function Mutation/genetics, Loss of Function Mutation, 2.1 Biological and endogenous factors, Genetics(clinical), Facial averaging, Aetiology, Child, Genetics & Heredity, Tousled-like, Biological Sciences, Deciphering Developmental Disorders Study, Biological sciences, intellectual disability, Child, Preschool, Female, facial averaging, Biotechnology, EMC NIHES-01-50-01-A, Adult, GENES, Adolescent, kinase, Bioinformatics and Computational Biology, 610, Translocation, Cell Line, Young Adult, Genetic, Clinical Research, Report, Genetics, Humans, RNA, Messenger, Preschool, Genetic Association Studies, Biomedical and Clinical Sciences, Radboudumc 7: Neurodevelopmental disorders DCMN: Donders Center for Medical Neuroscience, Base Sequence, TOUSLED-LIKE KINASES, MUTATIONS, Human Genome, Neurosciences, Health sciences, Facies, Infant, Radboudumc 9: Rare cancers RIHS: Radboud Institute for Health Sciences, Brain Disorders, Inheritance Patterns/genetics, haploinsufficiency, Neurodevelopmental Disorders, RNA, Messenger/genetics, Human Genetics - Radboud University Medical Center, Protein Kinases, ddc: ddc:

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
42
Top 10%
Top 10%
Top 10%
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