title: Chromosome Xq28 duplication encompassing MECP2: Clinical and molecular analysis of 16 new patients from 10 families in China.
abstract: BACKGROUND
  Chromosome Xq28 duplications encompassing methyl-CpG-binding protein 2 gene (MECP2) are observed most in males with a severe neurodevelopmental disorder associated with hypotonia, spasticity, severe learning disability, delayed psychomotor development, and recurrent pulmonary infections. Most female carriers are asymptomatic due to extremely or completely skewed X-inactivation.
  
  
  METHODS
  A retrospective clinical and molecular study was conducted to examine 16 patients and two fetuses from 10 families who were identified among patients with Xq28 duplications who presented at genetic clinics.
  
  
  RESULTS
  Of all 16 patients, 10 had a family history. Only one patient was female. All of the patients had no relevant pre-natal history. All of the patients exhibited severe psychomotor developmental delay, infantile hypotonia and recurrent infections. Some of the patients exhibited cardiac abnormalities, gastrointestinal mobility problems, hydrocele of tunica vaginalis, cryptorchidism, and autistic phenotypes. Additionally, neonatal kidney calculus, premature closure of the fontanel and pulmonary sequestration were found in the patients. Duplication sizes in these patients range from 0.21 to 14.391 Mb (most were smaller than 1 Mb), and all the duplications included host cell factor C1 (HCFC1), interleukin-1 receptor-associated kinase 1 (IRAK1), and MECP2. Bioinformatics analysis revealed that approximately half of the distal breakpoints were located within the low-copy repeats (LCRs), which may be involved in the recombination. The two fetuses were found to be healthy in the prenatal diagnosis.
  
  
  CONCLUSIONS
  This is the first large cohort of patients with MECP2 duplication syndrome, including a female, reported in China. Interestingly, neonatal kidney calculus, premature closure of the fontanel and pulmonary sequestration were first reported in this syndrome. However, it was difficult to distinguish if these patients represented unique cases or if these phenotypes can be considered as part of the syndrome. The correlation between the infrequent phenotypes and duplications/genes in the duplication region needs further systematic delineation. In conclusion, our study suggested that it is important to emphasize molecular genetic analysis in patients with developmental delay/intellectual disability and recurrent infections and that it is especially important for familial female carriers to accept prenatal diagnosis.
authors.affiliation: Department of Central Laboratory, Peking University First Hospital, Beijing, China.
authors.forename: Zhi
authors.initials: Z
authors.lastname: Yi
authors.affiliation: Department of Central Laboratory, Peking University First Hospital, Beijing, China. Electronic address: panmuren@263.net.
authors.forename: Hong
authors.initials: H
authors.lastname: Pan
authors.affiliation: Department of Central Laboratory, Peking University First Hospital, Beijing, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Central Laboratory, Peking University First Hospital, Beijing, China.
authors.forename: Hairong
authors.initials: H
authors.lastname: Wu
authors.affiliation: Department of Central Laboratory, Peking University First Hospital, Beijing, China.
authors.forename: Songtao
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Central Laboratory, Peking University First Hospital, Beijing, China.
authors.forename: Yinan
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Department of Central Laboratory, Peking University First Hospital, Beijing, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Qi
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002681:China; D058674:Chromosome Duplication / Q000235:genetics*; D055028:Comparative Genomic Hybridization / Q000379:methods; D019465:Craniofacial Abnormalities / Q000235:genetics* / Q000503:physiopathology; D002658:Developmental Disabilities / Q000235:genetics* / Q000503:physiopathology; D019066:Facies; D005260:Female; D020131:Genes, Duplicate; D040181:Genetic Diseases, X-Linked / Q000235:genetics* / Q000503:physiopathology; D006801:Humans; D007223:Infant; D008607:Intellectual Disability / Q000235:genetics* / Q000503:physiopathology; D008297:Male; D051783:Methyl-CpG-Binding Protein 2 / Q000235:genetics*; D010375:Pedigree; D010641:Phenotype; D056916:Segmental Duplications, Genomic; D025064:Sex Chromosome Disorders / Q000235:genetics* / Q000503:physiopathology; D049951:X Chromosome Inactivation / Q000235:genetics
chemical_list: C497392:MECP2 protein, human; D051783:Methyl-CpG-Binding Protein 2
keywords: Array CGH; Developmental delay/intellectual disability; MECP2 duplication; Recurrent infections; X chromosome inactivation