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Open Access Green as soon as Postprint is submitted to ZB.
Diagnostic exome sequencing in non-acquired focal epilepsies highlights a major role of GATOR1 complex genes.
J. Med. Genet. 57, 624-633 (2020)
Background The genetic architecture of non-acquired focal epilepsies (NAFEs) becomes increasingly unravelled using genome-wide sequencing datasets. However, it remains to be determined how this emerging knowledge can be translated into a diagnostic setting. To bridge this gap, we assessed the diagnostic outcomes of exome sequencing (ES) in NAFE. Methods 112 deeply phenotyped patients with NAFE were included in the study. Diagnostic ES was performed, followed by a screen to detect variants of uncertain significance (VUSs) in 15 well-established focal epilepsy genes. Explorative gene prioritisation was used to identify possible novel candidate aetiologies with so far limited evidence for NAFE. Results ES identified pathogenic or likely pathogenic (ie, diagnostic) variants in 13/112 patients (12%) in the genesDEPDC5,NPRL3,GABRG2,SCN1A,PCDH19andSTX1B. Two pathogenic variants were microdeletions involvingNPRL3andPCDH19. Nine of the 13 diagnostic variants (69%) were found in genes of the GATOR1 complex, a potentially druggable target involved in the mammalian target of rapamycin (mTOR) signalling pathway. In addition, 17 VUSs in focal epilepsy genes and 6 rare variants in candidate genes (MTOR,KCNA2, RBFOX1andSCN3A) were detected. Five patients with reported variants had double hits in different genes, suggesting a possible (oligogenic) role of multiple rare variants. Conclusion This study underscores the molecular heterogeneity of NAFE with GATOR1 complex genes representing the by far most relevant genetic aetiology known to date. Although the diagnostic yield is lower compared with severe early-onset epilepsies, the high rate of VUSs and candidate variants suggests a further increase in future years.
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Publication type
Article: Journal article
Document type
Scientific Article
Keywords
Epilepsy And Seizures ; Genetics ; Diagnostics ; Neurology; Variants; Mutations; Genetics; Pathway
ISSN (print) / ISBN
0022-2593
e-ISSN
1468-6244
Journal
Journal of Medical Genetics
Quellenangaben
Volume: 57,
Issue: 9,
Pages: 624-633
Publisher
BMJ Publishing Group
Publishing Place
British Med Assoc House, Tavistock Square, London Wc1h 9jr, England
Non-patent literature
Publications
Reviewing status
Peer reviewed