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Exome sequencing has found an excess of
de novo
mutations in the ∼4,000 most intolerant genes in patients with two classical epileptic encephalopathies (infantile spasms and Lennox–Gastaut syndrome); among them are multiple
de novo
mutations in
GABRB3
and
ALG13
.
Epilepsy-linked mutations revealed
An extensive exome sequencing study of patients with two 'classical' epileptic encephalopathies — infantile spasms and Lennox-Gastaut syndrome — has found an excess of
de novo
mutations in the approximately 4,000 genes that are the most intolerant to functional genetic variation in the human population. Among them are
de novo
mutations in
GABRB3
and
ALG13
, both showing statistical evidence of an association with epileptic encephalopathy. As in autism spectrum disorders, these
de novo
mutations are enriched in genes regulated by fragile X protein.
Epileptic encephalopathies are a devastating group of severe childhood epilepsy disorders for which the cause is often unknown
1
. Here we report a screen for
de novo
mutations in patients with two classical epileptic encephalopathies: infantile spasms (
n
= 149) and Lennox–Gastaut syndrome (
n
= 115). We sequenced the exomes of 264 probands, and their parents, and confirmed 329
de novo
mutations. A likelihood analysis showed a significant excess of
de novo
mutations in the ∼4,000 genes that are the most intolerant to functional genetic variation in the human population (
P
= 2.9 × 10
−3
). Among these are
GABRB3
, with
de novo
mutations in four patients, and
ALG13
, with the same
de novo
mutation in two patients; both genes show clear statistical evidence of association with epileptic encephalopathy. Given the relevant site-specific mutation rates, the probabilities of these outcomes occurring by chance are
P
= 4.1 × 10
−10
and
P
= 7.8 × 10
−12
, respectively. Other genes with
de novo
mutations in this cohort include
CACNA1A
,
CHD2
,
FLNA
,
GABRA1
,
GRIN1
,
GRIN2B
,
HNRNPU
,
IQSEC2
,
MTOR
and
NEDD4L.
Finally, we show that the
de novo
mutations observed are enriched in specific gene sets including genes regulated by the fragile X protein (
P
< 10
−8
), as has been reported previously for autism spectrum disorders
2
.