A NOVEL DE NOVO PARACENTRIC INVERSION [inv(20)(q13.1q13.3)] ACCOMPANIED BY AN 11q14.3-q21 MICRODELETION IN A PEDIATRIC PATIENT WITH AN INTELLECTUAL DISABILITY
Zachaki S, Kouvidi E, Mitrakos A, Lazaros L, Pantou A, Mavrou A, Tzetis M, Manola KN
*Corresponding Author: Dr. Sophia Zachaki, Genesis Genoma Lab, Kifisias Avenue 302, Chalandri, 15232, Athens, Greece. Tel.: +30-210-6803130. Fax: +30-210-6894778. E-mail: szachaki@genlab.gr
page: 63

DISCUSSION

A novel PAI of the long arm of chromosome 20 [inv(20) (q13.1q13.3)] is described in a patient with mental retardation. To the best of our knowledge, this case is the first reported PAI of 20q in the literature. Although the great majority of PAIs are familial (about 90.0%) [7], conventional cytogenetic analysis of the patientís parents revealed the de novo origin of this abnormality. In general, PAIs are balanced and have no phenotypic consequences for the carriers. However, in cases where microdeletions/microduplications occur at the breakpoints, an abnormal phenotype could result [3-5]. In our patient, aCGH showed a 100 kb microdeletion in the inverted segment at the 20q13.12 region-considered polymorphic CNP (copy number polymorphism), since it is reported in the database of genomic variance (DGV) and has not been associated with abnormal phenotypic features in carriers. Two other microdeletions at chromosomal regions 20q12 and 11q14.3q21, which were also found in our patient, were investigated for genes that could have contributed to the probandís phenotype. Constitutional deletions concerning larger segments of the long arm of chromosome 20 are very rare, with only eight cases reported so far [8-13], containing genes that may be responsible for the development of the heart and the brain. The 20q12 (1.97 Mb) microdeletion found in our proband contains one important OMIM morbid gene, MAFB, missense mutations of which have been reported to be responsible for autosomal dominant multicentric carpotarsal osteolysis (MCO) [14,15]. Furthermore, loss of MAFB function due to mutations or whole gene deletion, has been reported in the frame of Duane retraction syndrome (DRS) with or without deafness [15]. However, these cases are actually different from our proband due to lack of most of the phenotypic characteristics of the MCO and DRS syndromes. On the other hand, one case carrying a 20q12 deletion of 2.49 Mb has been published in DECIPHER (patient id: 267065). This patient carries a deletion containing 17 genes, including the MAFB gene. The childís phenotype has behavioral abnormality, delayed speech and language development, intellectual disability and sleep disturbance. The majority of 11q deletions are terminal and has been associated with a genetic disorder known as Jacobsen syndrome [16]. Interstitial 11q deletions are rare and only 35 cases have so far been described in the literature. They are highly heterogeneous in size and position and present with variable phenotypic characteristics, with most cases exhibiting mild to severe mental retardation, and as in our proband, developmental delay. However, in only six of the reported cases, the breakpoints of the deleted segment have been identified by molecular cytogenetic techniques [17,18], thus, it is hard to define the distinct genotype/ phenotype correlation of the 11q deletion. The common interstitial 11q deleted region contains the 4.5 Mb 11q14.3-11q21 microdeletion was also found in our proband [18]. The genes contained in the 11q14.3-11q21 microdeleted region in our proband are 36 and are characterized as genes with uncertain clinical significance. The most important one is MED17, for which many specific missense mutations have been reported in individuals with mental retardation, psychomotor delay and cerebellar atrophy, phenotypic features shared with our proband [19,20]. Apart from the reported MED17 mutation, one patient carrying a 6.38 Mb deletion containing the MED17 gene has also been reported in the DECIPHER database (patient id: 267158). This patient has tall stature, macrocephaly, autism, delayed speech and language development, echolalia and stereotypy. Therefore, it is possible that the 11q14.3-11q21 microdeletion may contribute to our patientís phenotype. In conclusion, this is the first report of a patient with an apparently balanced de novo 20q PAI, which after aCGH testing was not accompanied by microdeletions/ microduplications containing disease-associated genes near or at the breakpoints, indicating that it is probably not associated with the probandís abnormal phenotype. However, based on published data, the 11q14.3-11q21 micro-deletion detected by aCGH may be related to the mental retardation and developmental delay of the patient. As the published data about the 20q12 microdeletion are very few, it is not possible to correlate this finding with our patientís phenotype. This case report describes a new chromosomal entity with an important contribution to the management of prenatal diagnosis with similar findings. Array comparative genome hybridization is proven to be a useful technique for detecting unbalanced submicroscopic rearrangements with the exception of balanced chromosomal rearrangements and mosaicism of less than 20.0%. It could be offered prenatally or postnatally, in combination with conventional cytogenetic techniques, especially in cases of de novo karyotypically balanced chromosomal inversions or translocations or normal karyotype where an abnormal phenotype or mental retardation exists.



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