• Innovative cytogenomic diagnostics of neurodevelopmental disorders in children
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Innovative cytogenomic diagnostics of neurodevelopmental disorders in children

Ukrainian Journal of Perinatology and Pediatrics. 2023. 3(95): 71-78; doi 10.15574/PP.2023.95.71
Kirilova L. H.1, Miroshnikov O. O.1, Beregela O. V.1, Badiuk V. M.2, Filozop M. V.1, Dolenko O. O.2, Bondarenko Y. M.1
1SI «Institute of Paediatrics, Obstetrics and Gynaecology named after academician O.M. Lukyanova of the NAMS of Ukraine», Kyiv
2LLC «Ultragenome», Kyiv, Ukraine

For citation: Kirilova LH, Miroshnikov OO, Beregela OV, Badiuk VM, Filozop MV, Dolenko OO, Bondarenko YM. (2023). Innovative cytogenomic diagnostics of neurodevelopmental disorders in children. Ukrainian Journal of Perinatology and Pediatrics. 3(95): 71-78; doi 10.15574/PP.2023.95.71.
Article received: Jul 17, 2023. Accepted for publication: Sep 10, 2023.

Today, genetic diagnosis methods are a powerful tool for a practicing doctor, which allows not only to establish the etiology of neurodevelopmental disorders in children, but also influences the further tactics of patient management, the choice of further diagnostic and therapeutic interventions, helps in predicting subsequent pregnancies for the family.
Purpose – to analyze the information of modern specialized literature regarding the features of the use of modern cytogenetic methods of diagnosis, in particular, chromosomal micrometric analysis (СMA); give a clinical example of a child with a neurodevelopmental disorder and established chromosomal etiology.
A review of the scientific literature regarding the advantages and features of using innovative methods of cytogenetic diagnostics (karyotyping, СMA), clinical manifestations of 2q13 microdeletion syndrome is given.
A description of the clinical case of diagnosis of a child with 2q13 microdeletion syndrome is presented. A chromosomal micrometric analysis was performed, which revealed a heterozygous microdeletion on 2q13 with a size of 122 kilobases, which led to the loss of the NPHP1 and MALL genes. The obtained result of the CMA made it possible to optimize the tactics of monitoring the child, taking into account the increased risk of the development of kidney pathology and leukoencephalopathy, the recommended annual determination of the level of creatinine and urea in the blood, conducting an ultrasound of the kidneys and an MRI of the brain.
Conclusions. The given clinical observation confirms the complexity of the diagnostic search for neurodevelopmental disorders in children. In children with autism spectrum disorder, developmental delay, intellectual disability, in the absence of epileptic seizures, regardless of the presence of dysmorphic facial features, it is recommended to begin the examination with CMA, and in children with epileptic encephalopathies, it is optimal to begin the examination with the next generation sequencing method (NGS), namely whole exome sequencing.
The research was carried out in accordance with the principles of the Declaration of Helsinki. Informed consent of the children’s parents was obtained for the research.
No conflict of interests was declared by the authors.
Keywords: children, autism spectrum disorders, developmental delay, attention deficit hyperactivity disorder, intellectual disability, genetic testing, chromosomal microarray analysis, karyotyping, 2q13 microdeletion syndrome.
REFERENCES

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. 5th ed. American Psychiatric Publishing, Arlington. https://doi.org/10.1176/appi.books.9780890425596

2. Autism Genome Project Consortium, Szatmari P, Paterson AD, Zwaigenbaum L, Roberts W, Brian J et al. (2007). Mapping autism risk loci using genetic linkage and chromosomal rearrangements. Nature genetics. 39 (3): 319-328. https://doi.org/10.1038/ng1985; PMid:17322880 PMCid:PMC4867008

3. Batzir NA, Shohat M, Maya I. (2015, Sep). Chromosomal Microarray Analysis (CMA) a Clinical Diagnostic Tool in the Prenatal and Postnatal Settings. Pediatr Endocrinol Rev. 13 (1): 448-454. PMID: 26540760.

4. Cao Y, Luk HM, Zhang Y, Chau MHK, Xue S, Cheng SSW et al. (2022). Investigation of Chromosomal Structural Abnormalities in Patients With Undiagnosed Neurodevelopmental Disorders. Frontiers in genetics. 13: 803088. https://doi.org/10.3389/fgene.2022.803088; PMid:35495136 PMCid:PMC9046776

5. Fernandez BA, Scherer SW. (2017). Syndromic autism spectrum disorders: moving from a clinically defined to a molecularly defined approach. Dialogues in clinical neuroscience. 19(4): 353-371. https://doi.org/10.31887/DCNS.2017.19.4/sscherer; PMid:29398931 PMCid:PMC5789213

6. Flore LA, Milunsky JM. (2012). Updates in the genetic evaluation of the child with global developmental delay or intellectual disability. Seminars in pediatric neurology. 19 (4): 173-180. https://doi.org/10.1016/j.spen.2012.09.004; PMid:23245550

7. Guivarch J, Chatel C, Mortreux J, Missirian C, Philip N, Poinso F. (2018). An atypical autistic phenotype associated with a 2q13 microdeletion: a case report. Journal of medical case reports. 12 (1): 79. https://doi.org/10.1186/s13256-018-1620-4; PMid:29549886 PMCid:PMC5857311

8. Hladilkova E, Barøy T, Fannemel M, Vallova V, Misceo D, Bryn V et al. (2015). A recurrent deletion on chromosome 2q13 is associated with developmental delay and mild facial dysmorphisms. Molecular cytogenetics. 8: 57. https://doi.org/10.1186/s13039-015-0157-0; PMid:26236398 PMCid:PMC4521466

9. Kyrylova LH, Miroshnykov OO, Yuzva OO. (2020). Rozlady autystychnoho spektra v ditei rannoho viku: evoliutsiia pohliadiv ta mozhlyvosti diahnostyky. (Ch. 2). Mizhnar. nevrol. zhurn. 16; 5: 48-53. https://doi.org/10.22141/2224-0713.16.5.2020.209252

10. Kyrylova LH, Yuzva OO, Bondarenko ON, Berehela OV. (2023). Henetychni epileptychni ta rozvytkovi entsefalopatii rannoho viku: vid symptomiv do diahnozu. Neonatolohiia, khirurhiia ta perynatalna medytsyna. 8; 1 (43): 45-52. https://doi.org/10.24061/2413-4260.XIII.1.47.2023.7

11. Levy B, Wapner R. (2018, Feb). Prenatal diagnosis by chromosomal microarray analysis. Fertil Steril. 109 (2): 201-212. https://doi.org/10.1016/j.fertnstert.2018.01.005; PMid:29447663 PMCid:PMC5856154

12. Martin CL, Ledbetter DH. (2017). Chromosomal Microarray Testing for Children With Unexplained Neurodevelopmental Disorders. JAMA. 317 (24): 2545-2546. https://doi.org/10.1001/jama.2017.7272; PMid:28654998 PMCid:PMC7058144

13. Masini E, Loi E, Vega-Benedetti AF, Carta M, Doneddu G, Fadda R, Zavattari P. (2020). An Overview of the Main Genetic, Epigenetic and Environmental Factors Involved in Autism Spectrum Disorder Focusing on Synaptic Activity. International journal of molecular sciences. 21 (21): 8290. https://doi.org/10.3390/ijms21218290; PMid:33167418 PMCid:PMC7663950

14. Miller DT, Adam MP, Aradhya S, Biesecker LG, Brothman AR, Carter NP et al. (2010). Consensus statement: chromosomal microarray is a first-tier clinical diagnostic test for individuals with developmental disabilities or congenital anomalies. American journal of human genetics. 86 (5): 749-764. https://doi.org/10.1016/j.ajhg.2010.04.006; PMid:20466091 PMCid:PMC2869000

15. Morris-Rosendahl DJ, Crocq MA. (2020). Neurodevelopmental disorders-the history and future of a diagnostic concept. Dialogues in clinical neuroscience. 22 (1): 65-72. https://doi.org/10.31887/DCNS.2020.22.1/macrocq; PMid:32699506 PMCid:PMC7365295

16. Orphanet Report Series. (2022, Jan). Prevalence of rare diseases: Bibliographic data. URL: http://www.orpha.net/orphacom/cahiers/docs/GB/Prevalence_of_rare_diseases_by_decreasing_prevalence_or_cases.pdf.

17. Ozkan E, Lacerda MP. (2023, Jan). Genetics, Cytogenetic Testing And Conventional Karyotype. Treasure Island (FL): StatPearls Publishing. URL: https://www.ncbi.nlm.nih.gov/books/NBK563293/.

18. Palacios R, Jáuregui CG, Flores M, Palacios-Flores K. (2022). Copy Number Variation, Reference Module in Life Sciences. Elsevier. ISBN 9780128096338. https://doi.org/10.1016/B978-0-12-822563-9.00049-4

19. Rare Chromosome Disorder Support Group. (2012). Chromosome 1-1q211 microdeletion. Oxted: Unique. URL: https://www.rarechromo.org/media/information/Chromosome%20%201/1q21.1%20microdeletions%20FTNW.pdf.

20. Ream MA, Patel AD. (2015, Oct). Obtaining genetic testing in pediatric epilepsy. Epilepsia. 56 (10): 1505-1514. Epub 2015 Sep 8. https://doi.org/10.1111/epi.13122; PMid:26345167

21. Robert C, Pasquier L, Cohen D, Fradin M, Canitano R, Damaj L et al. (2017, Mar 12). Role of Genetics in the Etiology of Autistic Spectrum Disorder: Towards a Hierarchical Diagnostic Strategy. Int J Mol Sci. 18 (3): 618. https://doi.org/10.3390/ijms18030618; PMid:28287497 PMCid:PMC5372633

22. Rojnueangit K, Khetkham T, Onsod P, Chareonsirisuthigul T. (2020). Clinical Features to Predict 22q11.2 Deletion Syndrome Proven by Molecular Genetic Testing. Journal of pediatric genetics. 11 (1): 22-27. https://doi.org/10.1055/s-0040-1718386; PMid:35186386 PMCid:PMC8847066

23. Russell MW, Raeker MO, Geisler SB, Thomas PE, Simmons TA, Bernat JA et al. (2014). Functional analysis of candidate genes in 2q13 deletion syndrome implicates FBLN7 and TMEM87B deficiency in congenital heart defects and FBLN7 in craniofacial malformations. Hum Mol Genet. 23 (16): 4272-4284. https://doi.org/10.1093/hmg/ddu144; PMid:24694933

24. Rylaarsdam L, Guemez-Gamboa A. (2019). Genetic Causes and Modifiers of Autism Spectrum Disorder. Frontiers in cellular neuroscience. 13: 385. https://doi.org/10.3389/fncel.2019.00385; PMid:31481879 PMCid:PMC6710438

25. Srivastava S, Love-Nichols JA, Dies KA, Ledbetter DH, Martin CL, Chung WK et al. (2019). Meta-analysis and multidisciplinary consensus statement: exome sequencing is a first-tier clinical diagnostic test for individuals with neurodevelopmental disorders. Genetics in medicine : official journal of the American College of Medical Genetics. 21 (11): 2413-2421. https://doi.org/10.1038/s41436-019-0554-6; PMid:31182824 PMCid:PMC6831729

26. Wang L, Wang B, Wu C, Wang J, Sun M. (2023). Autism Spectrum Disorder: Neurodevelopmental Risk Factors, Biological Mechanism, and Precision Therapy. International journal of molecular sciences. 24 (3): 1819. https://doi.org/10.3390/ijms24031819; PMid:36768153 PMCid:PMC9915249

27. Yoon SH, Choi J, Lee WJ, Do JT. (2020). Genetic and Epigenetic Etiology Underlying Autism Spectrum Disorder. Journal of clinical medicine. 9 (4): 966. https://doi.org/10.3390/jcm9040966; PMid:32244359 PMCid:PMC7230567

28. Yu HE, Hawash K, Picker J, Stoler J, Urion D, Wu B-L et al. (2012). A recurrent 1.71 Mb genomic imbalance at 2q13 increases the risk of developmental delay and dysmorphism. Clin Genet. 81 (3): 257-264. https://doi.org/10.1111/j.1399-0004.2011.01637.x; PMid:21255006