目的 探讨表型和基因型分析在孤独症谱系障碍(ASD)早期诊断的临床应用。方法 对122名患者进行临床检查和评估,并利用遗传学技术对孤独症患者进行染色体核型分析和分子倒置探针技术(MIP)分析。结果 发现1例基因突变患儿,临床表型有典型孤独症症状、严重智力障碍和行为问题、有肌张力低、运动发育落后病史。头颅MRI示胼胝体发育不良和侧脑室轻度增大。9号染色体发生臂间倒位,核型为46,XX,inv(9)(p12q13)。患儿在孤独症易感基因DD3X3上存在一处杂合框移突变,家系验证结果显示为新发突变。结论 DDX3X是ASD易感基因,该基因变异会导致神经发育多种功能损害,且存在性别差异。ASD临床表型和遗传基因型的关联研究,为临床预警和早期诊断提供依据。
Abstract
Objective To discuss the application of phenotype and genotype of patients in the early diagnosis of autism spectrum disorder(ASD). Methods Physical examination, clinical evaluations were carried out in 122 patients, together by using G-banding karyotype analysis and molecular inversion probe. Results A mutational patient was present with typical autistic symptoms, severe intellectual disability, behavioral problems and the history of hypotonia and motor delay as well as corpus callosum hypoplasia and ventricular enlargement. A de novo frameshift mutation in the autism-related gene (DDX3X) was identified in the patient. There was an inverted 9 chromosome and the karyotype designation is 46, XX, inv(9) (p12q13). Conclusion The mutations of DDX3X are important risk factors of ASD which cause frequently multiple impairments of neurodevelopment and have differential effect by gender. The study of phenotype and genotype will provide important information for early warning and diagnosis in clinical.
关键词
孤独症谱系障碍 /
DDX3X基因 /
分子倒置探针技术 /
基因型 /
表型
Key words
autism spectrum disorder /
DDX3X gene /
molecular inversion probe /
genotype /
phenotype
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参考文献
[1] Lai MC, Lombardo MV, Baron-Cohen S. Autism[J]. Lancet, 2014, 383(9920):896-910.
[2] 陈秋如. 社交反应量表的修订和应用初步研究[D].广州:中山大学,2009.
[3] Nuttle X, Itsara A, Shendure J,et al., Resolving genomic disorder-associated breakpoints within segmental DNA duplications using massively parallel sequencing[J]. Nat Protoc, 2014,9(6):1496-1513.
[4] Blok LS, Madsen E, Juusola J, et al. Mutations in DDX3X are a common cause of unexplained intellectual disability with gender-specific effects on wnt signaling[J]. Am J Hum Genet,2015,97(2):343-352.
[5] Wang X, Rosenfeld JA, Bacino CA, et al. Phenotypic expansion in DDX3X-a common cause of intellectual disability in females[J/OL]. BioRxiv preprint first posted online[2018-05-18].doi: http://dx.doi.org/10.1101/283598.
[6] Kellaris G, Khan K, Baig SM, et al. A hypomorphic inherited pathogenic variant in DDX3X causes male intellectual disability with additional neurodevelopmental and neurodegenerative features[J]. Hum Genomics, 2018,12(1):11.
[7] Takata A, Miyake N, Tsurusaki Y, et al. Integrative analyses of de novo mutations provide deeper biological insights into autism spectrum disorder[J]. Cell Rep, 2018, 22(3):734-747.
[8] Serra A, Brahe C, Millington-ward A,et al. Pericentric inversion of chromosome 9: prevalence in 300 Down syndrome families and molecular studies of nondisjunction[J]. Am J Med Genet Suppl, 1990,7:162-168. [9] Demirhan O, Pazarbasi A, Suleymanova-karahan D,et al, Correlation of clinical phenotype with a pericentric inversion of chromosome 9 and genetic counseling[J]. Saudi Med J, 2008, 29(7):946-951.
[10] 李麓芸,夏家辉. 染色体病[M]. 北京: 科学出版社,1989:273.
[11] Lahn BT, Page DC. Functional coherence of the human Y chromosome[J]. Science,1997, 278:675-680.
[12] Jiang L, Gu ZH, Yan ZX, et al. Exome sequencing identifies somatic mutations of DDX3X in natural killer/T-cell lymphoma[J]. Nat Genet, 2015,47(9):1061-1066.
[13] Li Q, Zhang P, Zhang C,et al. DDX3X regulates cell survival and cell cycle during mouse early embryonic development[J]. J Biomed Res, 2014,28:282-291.
[14] Kasim V,Wu S, Taira, et al. Determination of the role of DDX3 a factor involved in mammalian RNAi pathway using an shRNA-expression library[J]. PLoS ONE,2013,8:e59445.
[15] Mentink RA, Middelkoop TC, Rella L, et al. Cell intrinsic modulation of Wnt signaling controls neuroblast migration in C elegans[J]. Dev Cell, 2014, 31:188-201.
[16] Zhang S, Li J, Lea R, et al. Fezf2 promotes neuronal differentiation through localized activation of Wnt/β-catenin signalling during forebrain development[J]. Development, 2014,141:4794-4805.
[17] Kellaris G, Khan K, Baig SM, et al. A hypomorphic inherited pathogenic variant in DDX3X causes male intellectual disability with additional neurodevelopmental and neurodegenerative features[J]. Hum Genomics,2018,12(1):11.
基金
2017年度广东省医学科研基金项目(A2017544)