In:
Journal of Medical Genetics, BMJ, Vol. 55, No. 10 ( 2018-10), p. 675-684
Abstract:
Brain arteriovenous malformations (BAVM) represent a congenital anomaly of the cerebral vessels with a prevalence of 10–18/100 000. BAVM is the leading aetiology of intracranial haemorrhage in children. Our objective was to identify gene variants potentially contributing to disease and to better define the molecular aetiology underlying non-syndromic sporadic BAVM. Methods We performed whole-exome trio sequencing of 100 unrelated families with a clinically uniform BAVM phenotype. Pathogenic variants were then studied in vivo using a transgenic zebrafish model. Results We identified four pathogenic heterozygous variants in four patients, including one in the established BAVM-related gene, ENG , and three damaging variants in novel candidate genes: PITPNM3 , SARS and LEMD3 , which we then functionally validated in zebrafish. In addition, eight likely pathogenic heterozygous variants ( TIMP3 , SCUBE2, MAP4K4, CDH2, IL17RD, PREX2, ZFYVE16 and EGFR ) were identified in eight patients, and 16 patients carried one or more variants of uncertain significance. Potential oligogenic inheritance ( MAP4K4 with ENG , RASA1 with TIMP3 and SCUBE2 with ENG ) was identified in three patients. Regulation of sma- and mad-related proteins (SMADs) (involved in bone morphogenic protein (BMP)/transforming growth factor beta (TGF-β) signalling) and vascular endothelial growth factor (VEGF)/vascular endotheliual growth factor recepter 2 (VEGFR2) binding and activity (affecting the VEGF signalling pathway) were the most significantly affected biological process involved in the pathogenesis of BAVM. Conclusions Our study highlights the specific role of BMP/TGF-β and VEGF/VEGFR signalling in the aetiology of BAVM and the efficiency of intensive parallel sequencing in the challenging context of genetically heterogeneous paradigm.
Type of Medium:
Online Resource
ISSN:
0022-2593
,
1468-6244
DOI:
10.1136/jmedgenet-2017-105224
DOI:
10.1136/jmedgenet-2017-105224.supp1
DOI:
10.1136/jmedgenet-2017-105224.supp5
DOI:
10.1136/jmedgenet-2017-105224.supp2
DOI:
10.1136/jmedgenet-2017-105224.supp3
DOI:
10.1136/jmedgenet-2017-105224.supp4
DOI:
10.1136/jmedgenet-2017-105224.supp6
DOI:
10.1136/jmedgenet-2017-105224.supp7
DOI:
10.1136/jmedgenet-2017-105224.supp8
DOI:
10.1136/jmedgenet-2017-105224.supp9
DOI:
10.1136/jmedgenet-2017-105224.supp10
DOI:
10.1136/jmedgenet-2017-105224.supp11
DOI:
10.1136/jmedgenet-2017-105224.supp12
DOI:
10.1136/jmedgenet-2017-105224.supp13
Language:
English
Publisher:
BMJ
Publication Date:
2018
detail.hit.zdb_id:
2009590-9
SSG:
12
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