title: Exome analysis of a family with pleiotropic congenital heart disease.
abstract: BACKGROUND
  A number of single gene defects have been identified in patients with isolated or nonsyndromic congenital heart defects (CHDs). However, due to significant genetic heterogeneity, candidate gene approaches have had limited success in finding high-risk alleles in most cases. The purpose of this study was to use exome sequencing to identify high-risk gene variants in a family with highly penetrant pleiotropic CHD.
  
  
  RESULTS
  DNA samples from 2 members of a family with diverse CHD were analyzed by exome sequencing. Variants were filtered to eliminate common variants and sequencing artifacts and then prioritized based on the predicted effect of the variant and on gene function. The remainder of the family was screened using polymerase chain reaction, high-resolution melting analysis, and DNA sequencing to evaluate variant segregation. After filtering, >2000 rare variants (including single nucleotide substitutions and indels) were shared by the 2 individuals. Of these, 46 were nonsynonymous, 3 were predicted to alter splicing, and 6 resulted in a frameshift. Prioritization reduced the number of variants potentially involved in CHD to 18. None of the variants completely segregated with CHD in the kindred. However, 1 variant, Myh6 Ala290Pro, was identified in all but 1 affected individual. This variant was previously identified in a patient with tricuspid atresia and large secundum atrial septal defect.
  
  
  CONCLUSIONS
  It is likely that next-generation sequencing will become the method of choice for unraveling the complex genetics of CHD, but information gained by analysis of transmission through families will be crucial.
authors.affiliation: Department of Pediatrics, Divisions of Cardiology and Medical Genetics, University of Utah School of Medicine, Salt Lake City, UT 84112, USA.
authors.forename: Cammon B
authors.initials: CB
authors.lastname: Arrington
authors.forename: Steven B
authors.initials: SB
authors.lastname: Bleyl
authors.forename: Norisada
authors.initials: N
authors.lastname: Matsunami
authors.forename: Gabriel D
authors.initials: GD
authors.lastname: Bonnell
authors.forename: Brith E M
authors.initials: BE
authors.lastname: Otterud
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Nielsen
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Stevens
authors.forename: Shawn
authors.initials: S
authors.lastname: Levy
authors.forename: Mark F
authors.initials: MF
authors.lastname: Leppert
authors.forename: Neil E
authors.initials: NE
authors.lastname: Bowles
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D059472:Exome; D005260:Female; D020022:Genetic Predisposition to Disease; D006330:Heart Defects, Congenital / Q000235:genetics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010375:Pedigree; D020641:Polymorphism, Single Nucleotide; D017422:Sequence Analysis, DNA; D055815:Young Adult