Neuropediatrics 2021; 52(04): 274-283
DOI: 10.1055/s-0041-1726306
Original Article

Pitfalls in Genetic Diagnostics: Why Phenotyping is Essential

Janina Gburek-Augustat
1   Division of Neuropediatrics, University Hospital, Hospital for Children and Adolescents, Leipzig, Germany
2   Clinic for Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
3   Department of Neuropediatrics, Developmental Neurology, Social Paediatrics, University Children's Hospital Tuebingen, Tuebingen, Germany
,
Jan-Christoph Schoene-Bake
2   Clinic for Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
4   Gemeinschaftspraxis fuer Humangenetik, Hamburg, Germany
,
Eva Bültmann
5   Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
,
Tobias Haack
6   Department of Medical Genetics and Applied Genomics, Rare Disease Center Tübingen, University of Tübingen, Tübingen, Germany
,
Rebecca Buchert
6   Department of Medical Genetics and Applied Genomics, Rare Disease Center Tübingen, University of Tübingen, Tübingen, Germany
,
Matthis Synofzik
7   Department for Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
,
Saskia Biskup
8   CeGaT GmbH, Center for Genomics and Transcriptomics, Tübingen, Germany
,
Friedrich Feuerhake
9   Institute for Pathology, Hannover Medical School, Hannover, Germany
,
Ina Sorge
10   Department of Pediatric Radiology, University Hospital Leipzig, Leipzig, Germany
,
Hans Hartmann
2   Clinic for Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
› Author Affiliations

Abstract

New genetic testing technologies have revolutionized medicine within the past years. It is foreseeable that the development will continue with the introduction of new techniques. Nevertheless, despite improved technology, an exact clinical description of the phenotype is still necessary and it is important to critically question findings, both before initiating genetic testing and when interpreting the results. We present four brief case vignettes to point out difficulties associated with correctly interpreting genetic findings.

Authors' Contributions

J.G.-A.: prepared the manuscript and clinically cared for cases 2, 3, and 4.


J.-C. S.-B.: prepared the manuscript and clinically cared for case 2.


E.B.: revised the manuscript and responsible for the magnetic resonance imaging findings in case 2.


T.H.: Revised the manuscript and was responsible for genetic diagnostics in case 2.


M.S.: revised the manuscript and clinically cared for case 4.


S.B.: revised the manuscript and was responsible for genetic diagnostics in cases 1 and 4.


F.F.: revised the manuscript and was responsible for the pathological assessment of the muscle biopsy in case 1.


I.S.: revised the manuscript and was responsible for the MRI findings in case 3.


H.H.: revised the manuscript comprehensively and clinically cared for cases 1, 2.


Ethics Approval and Consent to Participate and Consent for Publication

All patients were treated at university hospitals. The consent for treatment was signed by the parents at the outpatient presentation and for inpatient admission as part of the hospital formalities. This includes the consent for the publication of the medical data. For case 3, there is written consent from the parents to publish the photos with bars over the eyes.


Availability of Data and Material

The patient's findings and reports are documented in the electronical patient files.


Supplementary Material



Publication History

Received: 23 October 2020

Accepted: 27 January 2021

Article published online:
31 March 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Yang Y, Muzny DM, Reid JG. et al. Clinical whole-exome sequencing for the diagnosis of mendelian disorders. N Engl J Med 2013; 369 (16) 1502-1511
  • 2 Tan TY, Dillon OJ, Stark Z. et al. Diagnostic impact and cost-effectiveness of whole-exome sequencing for ambulant children with suspected monogenic conditions. JAMA Pediatr 2017; 171 (09) 855-862
  • 3 Córdoba M, Rodriguez-Quiroga SA, Vega PA. et al. Whole exome sequencing in neurogenetic odysseys: an effective, cost- and time-saving diagnostic approach. PLoS One 2018; 13 (02) e0191228
  • 4 Efthymiou S, Manole A, Houlden H. Next-generation sequencing in neuromuscular diseases. Curr Opin Neurol 2016; 29 (05) 527-536
  • 5 Theunissen TEJ, Nguyen M, Kamps R. et al. Whole exome sequencing is the preferred strategy to identify the genetic defect in patients with a probable or possible mitochondrial cause. Front Genet 2018; 9: 400
  • 6 Rauch A, Wieczorek D, Graf E. et al. Range of genetic mutations associated with severe non-syndromic sporadic intellectual disability: an exome sequencing study. Lancet 2012; 380 (9854): 1674-1682
  • 7 Vanderver A, Simons C, Helman G. et al; Leukodystrophy Study Group. Whole exome sequencing in patients with white matter abnormalities. Ann Neurol 2016; 79 (06) 1031-1037
  • 8 Ontario Health (Quality). Genome-wide sequencing for unexplained developmental disabilities or multiple congenital anomalies: a health technology assessment. Ont Health Technol Assess Ser 2020; 20 (11) 1-178
  • 9 Lohmann K, Klein C. Next generation sequencing and the future of genetic diagnosis. Neurotherapeutics 2014; 11 (04) 699-707
  • 10 Hennekam RCM, Biesecker LG. Next-generation sequencing demands next-generation phenotyping. Hum Mutat 2012; 33 (05) 884-886
  • 11 Frebourg T. The challenge for the next generation of medical geneticists. Hum Mutat 2014; 35 (08) 909-911
  • 12 Robin NH. Teaching dysmorphology in the era of genomics: new technologies, new learners. Curr Opin Pediatr 2018; 30 (06) 699-700
  • 13 Ronchi D, Di Fonzo A, Lin W. et al. Mutations in DNA2 link progressive myopathy to mitochondrial DNA instability. Am J Hum Genet 2013; 92 (02) 293-300
  • 14 Barraza-Flores P, Bates CR, Oliveira-Santos A, Burkin DJ. Laminin and Integrin in LAMA2-related congenital muscular dystrophy: from disease to therapeutics. Front Mol Neurosci 2020; 13: 1
  • 15 van der Knaap MS, Gajja S, Salomons GS. Leukoencephalopathy With Brain Stem and Spinal Cord Involvement and Lactate Elevation. In: Adam MP, Ardinger HH, Pagon RA. et al, eds. GeneReviews. Seattle, WA: University of Washington; 2010
  • 16 van Berge L, Hamilton EM, Linnankivi T. et al; LBSL Research Group. Leukoencephalopathy with brainstem and spinal cord involvement and lactate elevation: clinical and genetic characterization and target for therapy. Brain 2014; 137 (pt 4): 1019-1029
  • 17 Sukhudyan B, Jaladyan V, Melikyan G, Schlump JU, Boltshauser E, Poretti A. Gómez-López-Hernández syndrome: reappraisal of the diagnostic criteria. Eur J Pediatr 2010; 169 (12) 1523-1528
  • 18 Gómez MR. Cerebellotrigeminal and focal dermal dysplasia: a newly recognized neurocutaneous syndrome. Brain Dev 1979; 1 (04) 253-256
  • 19 Aldinger KA, Dempsey JC, Tully HM. et al. Rhombencephalosynapsis: fused cerebellum, confused geneticists. Am J Med Genet C Semin Med Genet 2018; 178 (04) 432-439
  • 20 Utz JR, Crutcher T, Schneider J, Sorgen P, Whitley CB. Biomarkers of central nervous system inflammation in infantile and juvenile gangliosidoses. Mol Genet Metab 2015; 114 (02) 274-280
  • 21 Sláma T, Garbade SF, Kölker S, Hoffmann GF, Ries M. Quantitative natural history characterization in a cohort of 142 published cases of patients with galactosialidosis-A cross-sectional study. J Inherit Metab Dis 2019; 42 (02) 295-302
  • 22 Köhler S, Carmody L, Vasilevsky N. et al. Expansion of the human phenotype ontology (HPO) knowledge base and resources. Nucleic Acids Res 2019; 47 (D1): D1018-D1027
  • 23 Hartley T, Balcı TB, Rojas SK. et al. The unsolved rare genetic disease atlas? An analysis of the unexplained phenotypic descriptions in OMIM. Am J Med Genet C Semin Med Genet 2018; 178 (04) 458-463