title: Revealing the complexity of a monogenic disease: rett syndrome exome sequencing.
abstract: Rett syndrome (OMIM#312750) is a monogenic disorder that may manifest as a large variety of phenotypes ranging from very severe to mild disease. Since there is a weak correlation between the mutation type in the Xq28 disease-gene MECP2/X-inactivation status and phenotypic variability, we used this disease as a model to unveil the complex nature of a monogenic disorder. Whole exome sequencing was used to analyze the functional portion of the genome of two pairs of sisters with Rett syndrome. Although each pair of sisters had the same MECP2 (OMIM*300005) mutation and balanced X-inactivation, one individual from each pair could not speak or walk, and had a profound intellectual deficit (classical Rett syndrome), while the other individual could speak and walk, and had a moderate intellectual disability (Zappella variant). In addition to the MECP2 mutation, each patient has a group of variants predicted to impair protein function. The classical Rett girls, but not their milder affected sisters, have an enrichment of variants in genes related to oxidative stress, muscle impairment and intellectual disability and/or autism. On the other hand, a subgroup of variants related to modulation of immune system, exclusive to the Zappella Rett patients are driving toward a milder phenotype. We demonstrate that genome analysis has the potential to identify genetic modifiers of Rett syndrome, providing insight into disease pathophysiology. Combinations of mutations that affect speaking, walking and intellectual capabilities may represent targets for new therapeutic approaches. Most importantly, we demonstrated that monogenic diseases may be more complex than previously thought.
authors.affiliation: Medical Genetics, University of Siena, Siena, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Grillo
authors.forename: Caterina
authors.initials: C
authors.lastname: Lo Rizzo
authors.forename: Laura
authors.initials: L
authors.lastname: Bianciardi
authors.forename: Veronica
authors.initials: V
authors.lastname: Bizzarri
authors.forename: Margherita
authors.initials: M
authors.lastname: Baldassarri
authors.forename: Ottavia
authors.initials: O
authors.lastname: Spiga
authors.forename: Simone
authors.initials: S
authors.lastname: Furini
authors.forename: Claudio
authors.initials: C
authors.lastname: De Felice
authors.forename: Cinzia
authors.initials: C
authors.lastname: Signorini
authors.forename: Silvia
authors.initials: S
authors.lastname: Leoncini
authors.forename: Alessandra
authors.initials: A
authors.lastname: Pecorelli
authors.forename: Lucia
authors.initials: L
authors.lastname: Ciccoli
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Mencarelli
authors.forename: Joussef
authors.initials: J
authors.lastname: Hayek
authors.forename: Ilaria
authors.initials: I
authors.lastname: Meloni
authors.forename: Francesca
authors.initials: F
authors.lastname: Ariani
authors.forename: Francesca
authors.initials: F
authors.lastname: Mari
authors.forename: Alessandra
authors.initials: A
authors.lastname: Renieri
mesh_terms: D000328:Adult; D015415:Biomarkers; D030541:Databases, Genetic; D059472:Exome; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D009154:Mutation; D018384:Oxidative Stress; D010375:Pedigree; D010641:Phenotype; D015518:Rett Syndrome / Q000235:genetics* / Q000378:metabolism; D017422:Sequence Analysis, DNA; D035781:Siblings; D055815:Young Adult
chemical_list: D015415:Biomarkers