Undiagnosed rare disease clinic identifies a novel <i>UBE3A</i> variant in two sisters with Angelman syndrome: The end of a diagnostic odyssey

  • Rebecca Bruns
    Indiana University School of Medicine Indianapolis Indiana USA
  • Khurram Liaqat
    Indiana University School of Medicine Indianapolis Indiana USA
  • Abdul Nasir
    Department of Anesthesiology Second Affiliated Hospital of Zhengzhou University Zhengzhou China
  • Kayla Treat
    Indiana University School of Medicine Indianapolis Indiana USA
  • Vinaya S. Murthy
    Indiana University School of Medicine Indianapolis Indiana USA
  • Lili Mantcheva
    Undiagnosed Rare Disease Clinic (URDC) Indiana University School of Medicine Indianapolis Indiana USA
  • Wilfredo Torres
    Indiana University School of Medicine Indianapolis Indiana USA
  • Erin Conboy
    Indiana University School of Medicine Indianapolis Indiana USA
  • Francesco Vetrini
    Indiana University School of Medicine Indianapolis Indiana USA

抄録

<jats:title>Abstract</jats:title><jats:p>Angelman syndrome (AS, MIM #105830) is a neurodevelopmental disorder characterized by severe intellectual disability, profound developmental delay, movement or balance problems, an excessively cheerful disposition, and seizures. AS results from inadequate expression of the maternal <jats:italic>UBE3A</jats:italic> gene (MIM #601623), which encodes an E3 ligase in the ubiquitin‐proteasome pathway. Here we present the case of two sisters with features consistent with AS who had negative methylation analyses. An autism/intellectual disability expanded panel revealed a maternally inherited novel <jats:italic>UBE3A</jats:italic> (NM_001354506.2) variant c.2443C>T p.(Pro815Ser) in both patients that was initially classified as a variant of uncertain significance. The patients were enrolled in Indiana University's Undiagnosed Rare Disease Clinic (URDC) to further investigate the variant. Additional data, including deep phenotyping, familial segregation analysis, and in silico studies, suggest that the variant is likely pathogenic. 3D modeling studies based on the available crystal structure revealed that the Pro815Ser variant can introduce more flexibility into the protein and alter its enzymatic activity. Recent literature confirms the pathogenic nature of the variant. Reanalysis of the <jats:italic>UBE3A</jats:italic> variant has heightened existing knowledge of AS and has offered this family an end to their diagnostic odyssey.</jats:p>

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