title: CLTC as a clinically novel gene associated with multiple malformations and developmental delay.
abstract: Diagnostic exome sequencing has recently emerged as an invaluable tool in determining the molecular etiology of cases involving dysmorphism and developmental delay that are otherwise unexplained by more traditional methods of genetic testing. Our patient was large for gestational age at 35 weeks, delivered to a 27-year-old primigravid Caucasian whose pregnancy was complicated by preeclampsia. Neonatal period was notable for hypoglycemia, apnea, bradycardia, hyperbilirubinemia, grade I intraventricular hemorrhage, subdural hematoma, laryngomalacia, hypotonia, and feeding difficulties. The patient had numerous minor dysmorphic features. At three and a half years of age, she has global developmental delays and nystagmus, and is being followed for a mediastinal neuroblastoma that is currently in remission. Karyotype and oligo-microarray were normal. Whole-exome, next generation sequencing (NGS) coupled to bioinformatic filtering and expert medical review at Ambry Genetics revealed 14 mutations in 9 genes, and these genes underwent medical review. A heterozygous de novo frameshift mutation, c.2737_2738dupGA p.D913Efs*59, in which two nucleotides are duplicated in exon 17 of the CLTC gene, results in substitution of glutamic acid for aspartic acid at position 913 of the protein, as well as a frame shift that results in a premature termination codon situated 58 amino acids downstream. Clathrin Heavy Chain 1 (CHC1) has been shown to play an important role in the brain for vesicle recycling and neurotransmitter release at pre-synaptic nerve terminals. There is also evidence implicating it in the proper development of the placenta during the early stages of pregnancy. The CLTC alteration identified herein is likely to provide an explanation for the patient's adverse phenotype. Ongoing functional studies will further define the impact of this alteration on CHC1 function and consequently, human disease.
authors.affiliation: Department of Pediatrics, Section of Medical Genetics, SUNY Upstate Medical University, Syracuse, New York.
authors.forename: Joseph
authors.initials: J
authors.lastname: DeMari
authors.affiliation: Ambry Genetics Corporation, Aliso Viejo, California.
authors.forename: Cameron
authors.initials: C
authors.lastname: Mroske
authors.affiliation: Ambry Genetics Corporation, Aliso Viejo, California.
authors.forename: Sha
authors.initials: S
authors.lastname: Tang
authors.affiliation: Department of Pediatrics, Section of Medical Genetics, SUNY Upstate Medical University, Syracuse, New York.
authors.forename: Joseph
authors.initials: J
authors.lastname: Nimeh
authors.affiliation: Department of Pediatrics, Section of Medical Genetics, SUNY Upstate Medical University, Syracuse, New York.
authors.forename: Ryan
authors.initials: R
authors.lastname: Miller
authors.affiliation: Department of Pediatrics, Section of Medical Genetics, SUNY Upstate Medical University, Syracuse, New York.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Lebel
mesh_terms: D000015:Abnormalities, Multiple / Q000175:diagnosis* / Q000235:genetics*; D002675:Child, Preschool; D020090:Chromosome Segregation; D033922:Clathrin Heavy Chains / Q000235:genetics*; D019295:Computational Biology; D002658:Developmental Disabilities / Q000175:diagnosis* / Q000235:genetics*; D019066:Facies; D005260:Female; D020440:Gene Duplication; D056726:Genetic Association Studies; D059014:High-Throughput Nucleotide Sequencing; D006801:Humans; D040582:Inheritance Patterns; D008297:Male
chemical_list: C543704:CLTC protein, human; D033922:Clathrin Heavy Chains
keywords: CLTC; clathrin; developmental delay; whole exome sequencing