Investigation of genetic and epigenetic mechanisms in human growth disorders

Author(s)

Adriano Bonaldi

• Document type: Doctoral Thesis
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Instituto de Biociências
• Defense date: 02 fev. 2016

Examining board members

Angela Maria Vianna Morgante; Alexander Augusto de Lima Jorge; Ana Cristina Victorino Krepischi; Regina Celia Mingroni Netto; Ester Silveira Ramos

• Advisor: Angela Maria Vianna Morgante

Abstract

A large number of patients with growth disorders do not have the cause of their clinical phenotype established, including about 50% of patients with Silver-Russell syndrome (SRS), and 10-20% of patients with Beckwith-Wiedemann syndrome (BWS). The aim of this study was to investigate the (epi)genetic causes of growth disorders of unknown etiology, in a contribution to the understanding of growth regulation. The study included: (1) the investigation of submicroscopic chromosomal imbalances, by aCGH, (2) the analysis of the allele-specific expression profile of imprinted genes (IG), by pyrosequencing (PSQ) or Sanger sequencing, in patients with growth restriction; (3) the investigation of global methylation pattern in patients with growth restriction, using methylation microarray. The cohort consisted of 41 unrelated patients with growth disorders: (1) 25, with the diagnostic hypothesis of SRS; (2) six, with intrauterine growth restriction and birth weight below the 10th centile, associated with other clinical signs; (3) seven, with the diagnostic hypothesis of BWS; and (4) three, with prenatal or postnatal macrosomia, associated with other clinical signs. Chromosomal microdeletions and microduplications were investigated in 40 patients. Fifty-eight rare variants were detected in 30/40 patients (75%): 40 were considered likely benign (18 patients, 45%), 12, of unknown pathogenic significance (11 patients, 27.5%), two, likely pathogenic (one patient, 2.5%), and four, pathogenic (three patients, 7.5%). These frequencies are similar to those described in studies investigating CNVs in groups of patients with growth disorders and other congenital abnormalities, including SRS, and show the importance of investigating chromosomal microimbalances in these patients. The diversity of CNVs identified can be attributed to the clinical heterogeneity of these cohorts. In this study, many of the patients, with the diagnostic hypothesis of SRS or BWS, had atypical clinical signs, thus explaining the absence of specific SRS/BWS (epi)genetic mutations. The identification of CNVs, known to be causative of other syndromes, reflected the overlapping of some of their clinical features with those of SRS and BWS. The analysis of IG allele-specific expression profile was performed in a subgroup of 18 patients with growth restriction. Thirty IGs were initially selected, based on their association with cell proliferation, fetal growth or neurodevelopment. Transcribed SNPs with high frequency in the general population were selected for the genotyping of patients, parents and control subjects, determination of IG expression in peripheral blood, and of the monoallelic or biallelic expression pattern. The allele-specific expression of 13 IGs expressed in blood was then investigated in patients (seven of them by PSQ and six by Sanger sequencing). Expression alterations of two normally paternally expressed genes were detected in 4/18 patients (22%). This study is the first to use pyrosequencing and Sanger sequencing in the evaluation of IG allele-specific expression profile, in patients with growth restriction. Despite the limitations, both techniques have proved to be robust, and revealed interesting alterations in allelic expression; however, the causal relationship of these alterations with the clinical phenotypes remained unclear. The investigation of the global DNA methylation was performed in a subgroup of 21 patients with growth restriction, and in 24 control subjects. Two types of analysis were performed: (1) group differential analysis, and (2) individual differential analysis. In the first analysis, the methylation pattern obtained for the group of patients with the diagnostic hypothesis of SRS (n=16) was compared to that of the control group (n=24); no bias towards DNA hypo or hypermethylation was detected in the SRS group. In the second analysis, the methylation patterns of each of the 21 patients with growth restriction, and each of the 24 control subjects were compared to the methylation pattern of the control group. The average numbers of hypermethylated CpGs and of differentially methylated segments (DMSs) were significantly higher in the patients. In total, 82 hypermethylated DMSs - 57 associated with gene(s) (69.5%), in 16 patients, and 51 hypomethylated DMSs - 41 associated with gene(s) (80.4%), in 10 patients, were identified. Gene ontology analysis of the 61 DMS-associated genes highlighted genes involved in development and morphogenesis of the skeletal system and fetal organs, and also in the regulation of gene transcription and metabolic processes. Methylation changes in genes involved with cellular proliferation and differentiation, and growth were identified in 9/20 patients (45%), suggesting clinical implications; an epigenetic mutation common to SRS patients was not detected, likely due to the clinical heterogeneity of the cohort. The data generated by this global methylation analysis, using microarray, might contribute to the understanding of molecular mechanisms in growth restriction. In an apparently balanced translocation -t(5;6)(q35.2;p22.3)dn, detected in a patient with the diagnostic hypothesis of SRS, a gene found to be disrupted by the chromosome 6 breakpoint might explain the phenotype; alternatively, the translocation might have impacted the regulation of developmental genes in the vicinity of breakpoints. Expression analysis showed a significant decrease in the disrupted gene cDNA levels in the patient\'s blood cells, as expected. In addition to the SRS typical signs, the patient presented clinical features suggestive of cleidocranial dysplasia. Thus, the translocation t(5;6) might have altered the interaction of developmental genes and regulatory elements, leading to misregulation of spatiotemporal gene expression, thus resulting in an atypical phenotype, with overlapping features of more than one genetic syndrome (AU)

• FAPESP's process: 11/12486-0 - Analysis of imprinted gene expression and chromosome microimbalances in growth disorders accompanied or not by intellectual disability
• Grantee: Adriano Bonaldi
• Support type: Scholarships in Brazil - Doctorate