Homozygote

纯合子
  • 文章类型: Journal Article
    目的:探索以全球发育迟缓和癫痫为特征的儿童的遗传基础。
    方法:选择2023年2月19日在广州市妇女儿童医学中心柳州医院就诊的儿童作为研究对象。收集患儿的临床资料。这个孩子接受了整个外显子组测序,候选变异体通过Sanger测序和生物信息学分析进行验证。
    结果:孩子,一个8个月大的女孩,表现为全球发育迟缓,癫痫,和高乳酸血症.颅骨MRI显示不同的骨髓增生性脑白质营养不良。脑电图显示背景活动缓慢。基因检测显示,她携带了SLC25A12基因的纯合变体,即c.115T>G(p.Phe39Val),她的父母都是杂合携带者。根据美国医学遗传学和基因组学学院的指南,预测该变体具有不确定的意义(PM2_支持+PM3_支持+PP3_中度+PP4_中度)。I-Mutantv3.0软件预测该变体可能会影响蛋白质产物的稳定性。
    结论:纯合c.115T>G(p。Phe39Val)SLC25A12基因的变异可能是该儿童疾病的发病机理。
    OBJECTIVE: To explore the genetic basis for a child featuring global developmental delay and epilepsy.
    METHODS: A child who had presented at Guangzhou Women and Children\'s Medical Center Liuzhou Hospital on February 19, 2023 was selected as the study subject. Clinical data of the child was collected. The child was subjected to whole exome sequencing, and candidate variant was validated by Sanger sequencing and bioinformatic analysis.
    RESULTS: The child, an 8-month-old girl, had manifested with global developmental delay, epilepsy, and hyperlactacidemia. Cranial MRI revealed diverse hypomyelinating leukodystrophies. Electroencephalogram showed slow background activities. Genetic testing revealed that she has harbored a homozygous variant of the SLC25A12 gene, namely c.115T>G (p.Phe39Val), for which both of her parents were heterozygous carriers. Based on the guidelines from the American College of Medical Genetics and Genomics, the variant was predicted to be of uncertain significance (PM2_Supporting+PM3_Supporting+PP3_Moderate+PP4_Moderate). I-Mutant v3.0 software predicted that the variant may affect the stability of protein product.
    CONCLUSIONS: The homozygous c.115T>G (p.Phe39Val) variant of the SLC25A12 gene probably underlay the pathogenesis of the disease in this child.
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  • 文章类型: Journal Article
    背景:层的育种强调卵相关性状的持续选择,比如产蛋,鸡蛋质量和蛋壳,这提高了他们的生产力,满足了市场的需求。随着繁殖过程的继续,层的基因组纯合性逐渐增加,导致纯合性(ROH)运行的出现。因此,ROH分析可以与其他方法结合使用以检测选择特征并鉴定与层育种中的各种重要性状相关的候选基因。
    结果:在这项研究中,我们从罗德岛红种群中的686只母鸡中获得了全基因组测序数据,该种群经历了连续15代的密集人工选择.我们进行了全基因组ROH分析,并利用多种方法来检测选择的特征。在整个人群中总共发现了141,720个ROH段,其中大多数(97.35%)长度小于3Mb。确定了23个ROH岛,它们与一些带有选择签名的区域重叠,通过多信号去相关复合方法(DCMS)检测。发现了60个基因,功能注释分析揭示了它们在生长中的可能作用,发展,免疫和信号层。此外,对44个层表型进行了包括DCMS和ROH的双尾分析,以找出个体的顶部和底部10%表型的亚组之间的基因组差异。结合GWAS的结果,我们观察到,与性状显著相关的区域在高低亚组之间也表现出选择特征.我们在GGA1的25Mb区域附近确定了与卵重显着相关的区域,该区域在低卵重亚群中表现出选择特征并具有较高的基因组纯合性。这表明该地区可能在鸡蛋重量的下降中起作用。
    结论:总之,通过对ROH的联合分析,选择签名,和GWAS,我们确定了几个与层的生产特征相关的基因组区域,层基因组的研究提供参考。
    BACKGROUND: The breeding of layers emphasizes the continual selection of egg-related traits, such as egg production, egg quality and eggshell, which enhance their productivity and meet the demand of market. As the breeding process continued, the genomic homozygosity of layers gradually increased, resulting in the emergence of runs of homozygosity (ROH). Therefore, ROH analysis can be used in conjunction with other methods to detect selection signatures and identify candidate genes associated with various important traits in layer breeding.
    RESULTS: In this study, we generated whole-genome sequencing data from 686 hens in a Rhode Island Red population that had undergone fifteen consecutive generations of intensive artificial selection. We performed a genome-wide ROH analysis and utilized multiple methods to detect signatures of selection. A total of 141,720 ROH segments were discovered in whole population, and most of them (97.35%) were less than 3 Mb in length. Twenty-three ROH islands were identified, and they overlapped with some regions bearing selection signatures, which were detected by the De-correlated composite of multiple signals methods (DCMS). Sixty genes were discovered and functional annotation analysis revealed the possible roles of them in growth, development, immunity and signaling in layers. Additionally, two-tailed analyses including DCMS and ROH for 44 phenotypes of layers were conducted to find out the genomic differences between subgroups of top and bottom 10% phenotype of individuals. Combining the results of GWAS, we observed that regions significantly associated with traits also exhibited selection signatures between the high and low subgroups. We identified a region significantly associated with egg weight near the 25 Mb region of GGA 1, which exhibited selection signatures and has higher genomic homozygosity in the low egg weight subpopulation. This suggests that the region may be play a role in the decline in egg weight.
    CONCLUSIONS: In summary, through the combined analysis of ROH, selection signatures, and GWAS, we identified several genomic regions that associated with the production traits of layers, providing reference for the study of layer genome.
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  • 文章类型: Journal Article
    背景:清远山雀鸡的几个核心育种和支持系,中国当地有代表性的鸡品种,已经发展了20多年。因此,通过育种选择和商业利用,其与生长和繁殖相关的经济性状得到了显着改善,但是一些特征,如part羽毛,肉质高,风味充足,一直被保留。然而,相似性状群体的遗传评估和功能基因探索缺乏有效的方法。相同的单倍型片段的存在从亲本传递到后代导致纯合性(ROH)的运行,提供有效的解决方案。在这项研究中,对分别代表两个繁殖种群和一个保存种群的134只清远part鸡的基因组进行了重新测序,以评估遗传多样性并通过分析多样性来探索功能基因,分布,和ROH的频率。
    结果:结果表明,在繁殖和保存的种群中,基因组连锁和近交程度都很低,这表明清远part鸡具有丰富的遗传多样性和足够的遗传潜力。在整个长期选拔过程中,21个基因,包括GLI3,ANO5,BLVRA,EFNB2、SLC5A12和SVIP,与品种特异性特征相关的积累在三个ROH岛内,而另外21个与生长性状相关的基因,包括IRX1,IRX2,EGFR,TPK1,NOVA1,BDNF等在五个ROH岛内积累。
    结论:这些发现为具有品种特异性和选择性特征的基因的遗传评估和鉴定提供了新的见解,为清远part鸡的育种和保护提供了坚实的遗传基础。
    BACKGROUND: Several core breeding and supporting lines of the Qingyuan partridge chicken, a representative local chicken breed in China, have been developed over 20 years. Consequently, its economic traits related to growth and reproduction have been significantly improved by breeding selection and commercial utilization, but some characteristic traits, such as partridge feathers, high meat quality and sufficient flavor, have always been retained. However, effective methods for genetic assessment and functional gene exploration of similar trait groups are lacking. The presence of identical haplotype fragments transmitted from parent to offspring results in runs of homozygosity (ROH), which offer an efficient solution. In this study, genomes of 134 Qingyuan partridge chickens representing two breeding populations and one preserved population were re-sequenced to evaluate the genetic diversity and explore functional genes by analyzing the diversity, distribution, and frequency of ROH.
    RESULTS: The results showed a low level of genomic linkage and degree of inbreeding within both the bred and preserved populations, suggesting abundant genetic diversity and an adequate genetic potential of the Qingyuan partridge chicken. Throughout the long-term selection process, 21 genes, including GLI3, ANO5, BLVRA, EFNB2, SLC5A12, and SVIP, associated with breed-specific characteristics were accumulated within three ROH islands, whereas another 21 genes associated with growth traits including IRX1, IRX2, EGFR, TPK1, NOVA1, BDNF and so on were accumulated within five ROH islands.
    CONCLUSIONS: These findings provide new insights into the genetic assessment and identification of genes with breed-specific and selective characteristics, offering a solid genetic basis for breeding and protection of Qingyuan partridge chickens.
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  • 文章类型: Journal Article
    了解本地山羊品种的遗传特征对于其保护和育种工作至关重要。海南黑山羊,作为中国南方热带岛屿省份海南的本地品种,拥有独特的特征,如黑发,适度的增长率,肉质好,身体尺寸小。然而,它们对粗糙的喂养条件表现出非凡的适应能力,拥有高品质的肉类,并对压力和热量表现出显著的抵抗力。在这项研究中,我们对海南黑山羊的全基因组进行了重新测序,以研究这些山羊的经济性状和遗传基础,我们利用来自33只海南黑山羊的全基因组测序数据来分析单核苷酸多态性(SNP)密度,纯合性(ROH)的运行,综合单倍型评分(iHS),有效种群规模(Ne),核苷酸多样性分析(Pi)和选择特征。我们的发现表明,海南黑山羊具有相当大的遗传变异,共鉴定出23.608.983个SNP。对ROHs的分析确定了53.710段,主要由短片段组成,近亲繁殖事件主要发生在古代祖先,海南黑山羊基于ROH的近亲繁殖估计值通常表现为0.107至0.186的中等值。这主要归因于近几代人有效人口规模的显著下降。此外,我们在ROH和iHS的交叉候选区域内鉴定出921个候选基因.这些基因中的几个与免疫等关键性状相关(PTPRC,HYAL1,HYAL2,HYAL3,CENPE和PKN1),耐热性(GNG2,MAPK8,CAPN2,SLC1A1和LEPR),肉质(ACOX1,SSTR1,CAMK2B,PPP2CA和PGM1),羊绒生产(AKT4、CHRM2、OXTR、AKT3,HMCN1和CDK19),和胁迫抗性(TLR2、IFI44、ENPP1、STK3和NFATC1)。这些基因的存在可能归因于海南黑山羊对当地气候条件的遗传适应。从这项研究中获得的见解提供了有价值的参考和坚实的基础,育种,海南黑山羊及其宝贵遗传资源的利用。
    Understanding the genetic characteristics of indigenous goat breeds is crucial for their conservation and breeding efforts. Hainan black goats, as a native breed of south China\'s tropical island province of Hainan, possess distinctive traits such as black hair, a moderate growth rate, good meat quality, and small body size. However, they exhibit exceptional resilience to rough feeding conditions, possess high-quality meat, and show remarkable resistance to stress and heat. In this study, we resequenced the whole genome of Hainan black goats to study the economic traits and genetic basis of these goats, we leveraged whole-genome sequencing data from 33 Hainan black goats to analyze single nucleotide polymorphism (SNP) density, Runs of homozygosity (ROH), Integrated Haplotype Score (iHS), effective population size (Ne), Nucleotide diversity Analysis (Pi) and selection characteristics. Our findings revealed that Hainan black goats harbor a substantial degree of genetic variation, with a total of 23 608 983 SNPs identified. Analysis of ROHs identified 53 710 segments, predominantly composed of short fragments, with inbreeding events mainly occurring in ancient ancestors, the estimates of inbreeding based on ROH in Hainan black goats typically exhibit moderate values ranging from 0.107 to 0.186. This is primarily attributed to significant declines in the effective population size over recent generations. Moreover, we identified 921 candidate genes within the intersection candidate region of ROH and iHS. Several of these genes are associated with crucial traits such as immunity (PTPRC, HYAL1, HYAL2, HYAL3, CENPE and PKN1), heat tolerance (GNG2, MAPK8, CAPN2, SLC1A1 and LEPR), meat quality (ACOX1, SSTR1, CAMK2B, PPP2CA and PGM1), cashmere production (AKT4, CHRM2, OXTR, AKT3, HMCN1 and CDK19), and stress resistance (TLR2, IFI44, ENPP1, STK3 and NFATC1). The presence of these genes may be attributed to the genetic adaptation of Hainan black goats to local climate conditions. The insights gained from this study provide valuable references and a solid foundation for the preservation, breeding, and utilization of Hainan black goats and their valuable genetic resources.
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  • 文章类型: Journal Article
    目的:探讨3例腰腿痛患儿的临床及遗传特点。
    方法:选择2018年6月至2020年3月在郑州大学第三附属医院确诊为中风的3例患儿作为研究对象。收集3例患儿的临床资料。对所有儿童进行全外显子组测序。通过Sanger测序和生物信息学分析验证候选变异体的致病性。
    结果:三个孩子都是男性,并在意外的听觉或触觉刺激下表现出夸张的惊吓反射和广义的僵硬,或者在夸张的惊吓之后经常有创伤性的跌倒。所有儿童都表现出积极的鼻子敲击反射,尽管脑电图和头颅MRI检查均为阴性。全外显子组测序显示,两个孩子携带GLRB基因的纯合变体,其中c.1017_c.1018insAG(p。G340Rfs*14)以前未报告。第三个孩子拥有GLRA1基因的复合杂合变体,其中c.1262T>A(p。IIe421Asn)变体显示出未报告的常染色体隐性遗传。所有儿童对氯硝西泮治疗反应良好。
    结论:腰痛患者有典型的临床表现。早期临床鉴定和遗传分析可以促进其诊断。
    OBJECTIVE: To explore the clinical and genetic characteristics of three children with Hyperekplexia.
    METHODS: Three children who were diagnosed with Hyperekplexia at the Third Affiliated Hospital of Zhengzhou University between June 2018 and March 2020 were selected as the study subjects. Clinical data of the three children were collected. All children were subjected to whole exome sequencing. Pathogenicity of candidate variants were verified by Sanger sequencing and bioinformatic analysis.
    RESULTS: The three children were all males, and had presented exaggerated startle reflexes and generalized stiffness in response to unexpected auditory or tactile stimulation, or had frequent traumatic falls following exaggerated startle. All children had shown positive nose-tapping reflex, though EEG and cranial MRI exams were all negative. Whole exome sequencing revealed that two children had harbored homozygous variants of the GLRB gene, of which the c.1017_c.1018insAG (p.G340Rfs*14) was unreported previously. The third child had harbored compound heterozygous variants of the GLRA1 gene, among which the c.1262T>A (p.IIe421Asn) variant showed an unreported autosomal recessive inheritance. All children had responded well to clonazepam treatment.
    CONCLUSIONS: Patients with Hyperekplexia have typical clinical manifestations. Early clinical identification and genetic analysis can facilitate their diagnosis.
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  • 文章类型: Journal Article
    背景:17α-羟化酶/17,20-裂解酶缺乏症(17OHD)是由细胞色素P450,家族17,亚家族A的突变引起的常染色体隐性遗传障碍,多肽1(CYP17A1)。本研究报告了一名22岁的中国患者(46,XY)患有17OHD和单侧肾上腺占位性病变的病例。
    方法:患者接受血清学检查,射线照相,遗传,和分子分析,包括通过高通量测序(HTS)技术进行全基因组外显子组测序,以分析患者及其父母的遗传状况。此外,进行染色体核型分析.通过使用SWISS-MODEL网站工具(PDB代码3RUK)检查人CYP17A1的三维结构,研究了新突变对蛋白质构象的影响。
    结果:患者的染色体核型为46,XY,并伴有高血压,低钾血症,和男性假两性畸形。此外,睾丸激素水平下降,硫酸脱氢表雄酮,和雌二醇,随着孕酮水平的增加,黄体生成素,和卵泡刺激素(FSH),被观察到。DNA测序显示纯合突变(c.908G>A,p.G303A)在CYP17A1的第五外显子中。父母双方在同一外显子携带杂合的c.908G>A突变,确认患者外显子突变的遗传。
    结论:第一次,这项研究报道了CYP17A1中的一个新的纯合突变(第5外显子c.908G>A)。CYP17A1的建模分析表明,在位置303用天冬氨酸取代甘氨酸会引起数量的改变,结构,以及蛋白质局部结合位点的静电势。p.G303A突变可能具有致病特性。我们的研究扩展了CYP17A1的突变谱。
    BACKGROUND: 17α-hydroxylase/17,20-lyase deficiency (17OHD) is an autosomal recessive genetic disorder caused by a mutation of the cytochrome P450, family 17, subfamily A, polypeptide 1 (CYP17A1). This study reports the case of a 22-year-old Chinese patient (46, XY) with 17OHD and a unilateral adrenal space-occupying lesion.
    METHODS: The patient underwent serological, radiographic, genetic, and molecular analyses including whole-genome exome sequencing through high-throughput sequencing (HTS) technology to analyze the genetic conditions of both the patient and her parents. Additionally, chromosomal karyotype analysis was performed. The impact of the novel mutation on protein conformation was investigated by examining the three-dimensional structure of human CYP17A1 using the SWISS-MODEL website tool (PDB code 3RUK).
    RESULTS: The patient had a chromosomal karyotype 46, XY, and presented with hypertension, hypokalemia, and male pseudohermaphroditism. Furthermore, decreased levels of testosterone, dehydroepiandrosterone sulfate, and estradiol, along with increased levels of progesterone, luteinizing hormone, and follicle-stimulating hormone (FSH), were observed. DNA sequencing revealed a homozygous mutation (c.908G>A, p.G303A) in the fifth exon of the CYP17A1. Both parents carried a heterozygous c.908G>A mutation in the same exon, confirming the inheritance of the patient\'s exonic mutation.
    CONCLUSIONS: For the first time, this study reports a novel homozygous mutation (c.908G>A in the fifth exon) in CYP17A1. Modeling analysis of CYP17A1 suggested that the substitution of glycine with aspartic acid at position 303 induces alterations in the number, structure, and electrostatic potential of the protein\'s local binding sites. The p.G303A mutation may possess pathogenic properties. Our study expands the mutation spectrum of CYP17A1.
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  • 文章类型: Journal Article
    RHOH,主要在造血细胞中表达的非典型小GTP酶,在免疫功能中起着至关重要的作用。RHOH的缺乏与疣状表皮发育不良有关,肺部疾病,伯基特淋巴瘤和T细胞缺陷。这里,我们报告了一种新的种系纯合RHOHc.245G>A(p。Cys82Tyr)在患有复发性疾病的21岁男性中变异,侵入性,影响肺部的机会性感染,眼睛,和大脑。他的妹妹在成年早期也死于肺部感染。患者表现出持续的CD4+T下降,B,和NK细胞计数,和低免疫球蛋白血症.患者的T细胞在体外TCR刺激后显示出受损的活化。在用RHOHC82Y转导的JurkatT细胞中,观察到激活标志物CD69上调的类似减少.此外,C82Y变体显示降低的RHOH蛋白表达和受损的与TCR信号分子ZAP70的相互作用。一起,这些数据表明,新发现的常染色体隐性遗传RHOH变异与T细胞功能障碍和复发性机会性感染有关,通过破坏ZAP70介导的TCR信号传导而发挥次形态的功能。
    RHOH, an atypical small GTPase predominantly expressed in hematopoietic cells, plays a vital role in immune function. A deficiency in RHOH has been linked to epidermodysplasia verruciformis, lung disease, Burkitt lymphoma and T cell defects. Here, we report a novel germline homozygous RHOH c.245G > A (p.Cys82Tyr) variant in a 21-year-old male suffering from recurrent, invasive, opportunistic infections affecting the lungs, eyes, and brain. His sister also succumbed to a lung infection during early adulthood. The patient exhibited a persistent decrease in CD4+ T, B, and NK cell counts, and hypoimmunoglobulinemia. The patient\'s T cell showed impaired activation upon in vitro TCR stimulation. In Jurkat T cells transduced with RHOHC82Y, a similar reduction in activation marker CD69 up-regulation was observed. Furthermore, the C82Y variant showed reduced RHOH protein expression and impaired interaction with the TCR signaling molecule ZAP70. Together, these data suggest that the newly identified autosomal-recessive RHOH variant is associated with T cell dysfunction and recurrent opportunistic infections, functioning as a hypomorph by disrupting ZAP70-mediated TCR signaling.
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  • 文章类型: Journal Article
    背景:土著鸡是通过自然选择和人工选择相结合而开发的;本质上,基因组的变化通过混合事件导致了这些现代品种的形成。然而,他们令人困惑的遗传背景包括调节复杂性状的基因组足迹,不利于现代动物育种。
    结果:为了更好地评估本地鸡驯化的候选区域,我们考虑了13只本地鸡的纯合性(ROHs)和选择性特征。Silkie羽毛鸡的基因组呈现出最高的杂合性,而在鲁花鸡中发现了最高的近亲繁殖状态和ROH数。短路功率(<1Mb),是所有鸡的主要类型。共检测出291个ROH岛,QTLdb作图结果表明,体重和car体性状是最重要的性状。在12个种群中检测到覆盖VSTM2A基因的2号染色体ROH。结合Tajima的D指数分析显示,18个基因(例如,VSTM2A,BBOX1和RYR2)处于选择范围内,并被ROH岛覆盖。转录分析结果显示,RYR2和BBOX1在心脏和肌肉组织中特异性表达,分别。
    结论:基于ROH和选择性特征的全基因组扫描,我们评估了基因组特征,并检测到被ROH岛和选择性特征覆盖的重要候选基因.这项研究的发现促进了对遗传多样性的理解,并为鸡的育种和保护策略提供了有价值的见解。
    BACKGROUND: Indigenous chickens were developed through a combination of natural and artificial selection; essentially, changes in genomes led to the formation of these modern breeds via admixture events. However, their confusing genetic backgrounds include a genomic footprint regulating complex traits, which is not conducive to modern animal breeding.
    RESULTS: To better evaluate the candidate regions under domestication in indigenous chickens, we considered both runs of homozygosity (ROHs) and selective signatures in 13 indigenous chickens. The genomes of Silkie feather chickens presented the highest heterozygosity, whereas the highest inbreeding status and ROH number were found in Luhua chickens. Short ROH (< 1 Mb), were the principal type in all chickens. A total of 291 ROH islands were detected, and QTLdb mapping results indicated that body weight and carcass traits were the most important traits. An ROH on chromosome 2 covering VSTM2A gene was detected in 12 populations. Combined analysis with the Tajima\'s D index revealed that 18 genes (e.g., VSTM2A, BBOX1, and RYR2) were under selection and covered by ROH islands. Transcriptional analysis results showed that RYR2 and BBOX1 were specifically expressed in the heart and muscle tissue, respectively.
    CONCLUSIONS: Based on genome-wide scanning for ROH and selective signatures, we evaluated the genomic characteristics and detected significant candidate genes covered by ROH islands and selective signatures. The findings in this study facilitated the understanding of genetic diversity and provided valuable insights for chicken breeding and conservation strategies.
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  • 文章类型: Journal Article
    目的:关于不确定的急性肝衰竭(ALF)的数据有限。该研究旨在使用遗传方法对病因不确定的ALF病例进行事后分析。
    方法:收集这些患有不确定ALF的患者的血液样本。全外显子组测序(WES)用于评估不确定ALF的发病机理。
    结果:共有来自11名成人患者和5名患有不确定ALF的儿科患者的16个样本。在成年患者中,一名女性患者被鉴定为具有两个杂合变体(c.2333G>T(p。Arg778Leu)和c.2310C>G(p。Leu770=))在腺苷三磷酸酶铜转运β(ATP7B)基因中,发现两名男性患者具有杂合和纯合变体(c.686C>A(p。Pro229Gln)加纯合变体A(TA)6TAAinsTA(-),和c.1456T>G(p。Tyr486Asp)加上c.211G>A(p。Gly71Arg))在尿苷二磷酸葡萄糖醛酸基转移酶1A1(UGT1A1)基因中。对于儿科患者来说,单个杂合变体(c.2890C>T(p。Arg964Cys))中的聚合酶γ(POLG)基因在1个男性儿童中被发现,和两个杂合变体(c.1909A>G(p。Lys637Glu)和c.3646G>A(p。Val1216Ile))在1名女童中发现了四肽重复结构域37(TTC37)基因。在其余患者中未发现与已知肝脏疾病相关的临床变异。
    结论:这些结果扩大了对病因不确定的ALF的认识。WES有助于揭示不确定ALF的可能候选基因,但是在某些情况下,基因型和表型之间的不完全一致性仍然对准确诊断提出了挑战。
    OBJECTIVE: There are limited data regarding indeterminate acute liver failure (ALF). The study aims to perform a post hoc analysis using genetic methods for the ALF cases with indeterminate etiology.
    METHODS: Stored blood samples from these patients with indeterminate ALF were collected. Whole-exome sequencing (WES) was used to evaluate the pathogenesis of indeterminate ALF.
    RESULTS: A total of 16 samples from 11 adult patients and 5 pediatric patients with indeterminate ALF were available. Among the adult patients, one female patient was identified with two heterozygous variants (c.2333G > T (p.Arg778Leu) and c.2310C > G (p.Leu770 = )) in the adenosine triphosphatase copper-transporting beta (ATP7B) gene, and two male patients were found to harbor heterozygous and homozygous variants (c.686C > A (p.Pro229Gln) plus homozygousvariantA(TA)6TAAinsTA (-), andc.1456 T > G (p.Tyr486Asp) plus c.211G > A (p.Gly71Arg)) in the uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) gene. For the pediatric patients, single heterozygous variant (c.2890C > T (p.Arg964Cys)) in the polymerase gamma (POLG) gene was found in 1 male child, and two heterozygous variants (c.1909A > G (p.Lys637Glu) and c.3646G > A (p.Val1216Ile)) in the tetratricopeptide repeat domain 37 (TTC37) gene were found in 1 female child. No variants clinically associated with known liver diseases were revealed in the remaining patients.
    CONCLUSIONS: These results expand the knowledge of ALF with indeterminate etiology. WES is helpful to reveal possible candidate genes for indeterminate ALF, but incomplete consistency between the genotype and phenotype in some cases still challenge the accurate diagnosis.
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