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Molecular Case Studies
Article . 2020 . Peer-reviewed
Data sources: Crossref
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Molecular Case Studies
Article
License: CC BY NC
Data sources: UnpayWall
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PubMed Central
Article . 2020
License: CC BY NC
Data sources: PubMed Central
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Reticular dysgenesis caused by an intronic pathogenic variant in AK2

Authors: Shoji Ichikawa; Susan Prockop; Charlotte Cunningham-Rundles; Travis Sifers; Blair R. Conner; Sitao Wu; Rachid Karam; +2 Authors

Reticular dysgenesis caused by an intronic pathogenic variant in AK2

Abstract

Reticular dysgenesis is a form of severe combined immunodeficiency (SCID) caused by biallelic pathogenic variants in AK2. Here we present the case of a boy diagnosed with SCID following a positive newborn screen (NBS). Genetic testing revealed a homozygous variant: AK2 c.330 + 5G > A. In silico analyses predicted weakened native donor splice site. However, this variant was initially classified as a variant of uncertain significance (VUS) given lack of direct evidence. To determine the impact on splicing, we analyzed RNA from the proband and his parents, using massively parallel RNA-seq of cloned RT-PCR products. Analysis showed that c.330 + 5G > A results in exon 3 skipping, which encodes a critical region of the AK2 protein. With these results, the variant was upgraded to pathogenic, and the patient was given a diagnosis of reticular dysgenesis. Interpretation of VUS at noncanonical splice site nucleotides presents a challenge. RNA sequencing provides an ideal platform to perform qualitative and quantitative assessment of intronic VUS, which can lead to reclassification if a significant impact on mRNA is observed. Genetic disorders of hematopoiesis and immunity represent fruitful areas to apply RNA-based analysis for variant interpretation given the high expression of RNA in blood.

Keywords

Male, Peripheral Blood Stem Cell Transplantation, RNA Splicing, Adenylate Kinase, DNA Mutational Analysis, Infant, Newborn, Genetic Variation, Infant, Research Reports, Exons, Leukopenia, Introns, Phenotype, Treatment Outcome, Mutation, Humans, Genetic Predisposition to Disease, Severe Combined Immunodeficiency, Alleles, Genetic Association Studies

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    5
    popularity
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    Top 10%
    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
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    impulse
    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
    Top 10%
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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!
5
Top 10%
Average
Top 10%
Green
gold