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Defining different genetic subtypes of autism spectrum disorder (ASD) can enable the prediction of developmental outcomes. Based on minor physical and major congenital anomalies, we categorized 325 Canadian children with ASD into dysmorphic and nondysmorphic subgroups. We developed a method for calculating a patient-level, genome-wide rare variant score (GRVS) from whole-genome sequencing (WGS) data. GRVS is a sum of the number of variants in morphology-associated coding and non-coding regions, weighted by their effect sizes. Probands with dysmorphic ASD had a significantly higher GRVS compared to those with nondysmorphic ASD (P= 0.027). Using the polygenic transmission disequilibrium test, we observed an over-transmission of ASD-associated common variants in nondysmorphic ASD probands (P= 2.9×10−3). These findings replicated using WGS data from 442 ASD probands with accompanying morphology data from the Simons Simplex Collection. Our results provide support for an alternative genomic classification of ASD subgroups using morphology data, which may inform intervention protocols.

Purpose\ud Much of the heredity of melanoma remains unexplained. We sought predisposing germline copy-number variants using a rare disease approach.\ud \ud Methods\ud Whole-genome copy-number findings in patients with melanoma predisposition syndrome congenital melanocytic nevus were extrapolated to a sporadic melanoma cohort. Functional effects of duplications in PPP2R3B were investigated using immunohistochemistry, transcriptomics, and stable inducible cellular models, themselves characterized using RNAseq, quantitative real-time polymerase chain reaction (qRT-PCR), reverse phase protein arrays, immunoblotting, RNA interference, immunocytochemistry, proliferation, and migration assays.\ud \ud Results\ud We identify here a previously unreported genetic susceptibility to melanoma and melanocytic nevi, familial duplications of gene PPP2R3B. This encodes PR70, a regulatory unit of critical phosphatase PP2A. Duplications increase expression of PR70 in human nevus, and increased expression in melanoma tissue correlates with survival via a nonimmunological mechanism. PPP2R3B overexpression induces pigment cell switching toward proliferation and away from migration. Importantly, this is independent of the known microphthalmia-associated transcription factor (MITF)-controlled switch, instead driven by C21orf91. Finally, C21orf91 is demonstrated to be downstream of MITF as well as PR70.\ud \ud Conclusion\ud This work confirms the power of a rare disease approach, identifying a previously unreported copy-number change predisposing to melanocytic neoplasia, and discovers C21orf91 as a potentially targetable hub in the control of phenotype switching.

The majority of the heredity of melanoma remains unexplained, however inherited copy number changes have not yet been systematically studied. The genetic environment is highly relevant to treatment stratification, and new gene discovery is therefore desirable. Using an unbiased whole genome screening approach for copy number we identify here a novel melanoma predisposing factor, familial duplications of genePPP2R3B, encoding a regulatory unit of critical phosphatase PP2A. Significant correlation between expression ofPPP2R3Bin tumour tissue and survival in a large melanoma cohort was confirmed, and associated with a non-immunological expression profile. Mechanistically, construction and extensive characterization of a stable, inducible cellular model forPPP2R3Boverexpression revealed induction of pigment cell switching towards proliferation and away from migration. Importantly, this was independent of the known microphthalmia-associated transcription factor(MITF)-controlled pigment cell phenotype switch, and was instead driven by uncharacterised geneC21orf91. Bioinformatic studies point toC21orf91as a novel target ofMITF,and therefore a potential hub in the control of phenotype switching in melanoma. This study identifies novel germline copy number variants inPPP2R3Bpredisposing to melanocytic neoplasia, and uncovers a new potential therapeutic targetC21orf91in the control of pigment cell proliferation.

Purpose Hemiplegia is a subtype of cerebral palsy (CP) in which one side of the body is affected. Our earlier study of unselected children with CP demonstrated de novo and clinically relevant rare inherited genomic copy-number variations (CNVs) in 9.6% of participants. Here, we examined the prevalence and types of CNVs specifically in hemiplegic CP. Methods We genotyped 97 unrelated probands with hemiplegic CP and their parents. We compared their CNVs to those of 10,851 population controls, in order to identify rare CNVs (

We are performing whole genome sequencing (WGS) of families with Autism Spectrum Disorder (ASD) to build a resource, named MSSNG, to enable the sub-categorization of phenotypes and underlying genetic factors involved. Here, we report WGS of 5,205 samples from families with ASD, accompanied by clinical information, creating a database accessible in a cloud platform, and through an internet portal with controlled access. We found an average of 73.8 de novo single nucleotide variants and 12.6 de novo insertion/deletions (indels) or copy number variations (CNVs) per ASD subject. We identified 18 new candidate ASD-risk genes such as MED13 and PHF3, and found that participants bearing mutations in susceptibility genes had significantly lower adaptive ability (p=6×10−4). In 294/2,620 (11.2%) of ASD cases, a molecular basis could be determined and 7.2% of these carried CNV/chromosomal abnormalities, emphasizing the importance of detecting all forms of genetic variation as diagnostic and therapeutic targets in ASD.

IMMP2L, the gene encoding the inner mitochondrial membrane peptidase subunit 2-like protein, has been reported as a candidate gene for Tourette syndrome, autism spectrum disorder (ASD) and additional neurodevelopmental disorders. Here we genotyped 100 trio families with an index proband with autism spectrum disorder in Han Chinese population and found three cases with rare exonic IMMP2L deletions. We have conducted a comprehensive meta-analysis to quantify the association of IMMP2L deletions with ASD using 5,568 cases and 10,279 controls. While the IMMP2L deletions carried non-recurrent breakpoints, in contrast to previous reports, our meta-analysis found no evidence of association (P > 0.05) between IMMP2L deletions and ASD. We also observed common exonic deletions impacting IMMP2L in a separate control (5,971 samples) cohort where subjects were screened for psychiatric conditions. This is the first systematic review and meta-analysis regarding the effect of IMMP2L deletions on ASD, but further investigations in different populations, especially Chinese population may be still needed to confirm our results.

Background Genetics play an important role in ADHD and OCD but only a handful of mostly common risk variants have been identified in studies that compare ADHD/OCD patients with healthy controls. Copy number variants of high penetrance may play an important role in childhood neuropsychiatric disorders. Our current knowledge of CNVs in ADHD and OCD is based on relatively small samples of patients, and to interpret the significance of these CNVs we need to assess risk CNVs in the general population. To this end we determine the frequency of clinically relevant CNVs in a large population based sample of children and adolescents and examined the association of rare CNVs with ADHD and OCD traits. Methods Quantitative data on ADHD traits using the Strengths and Weaknesses of ADHD and Normal Behavior (SWAN) scale and OC traits using the Toronto Obsessive-Compulsive scale (TOCS) was collected from 17,263 youth (ages 6-17 years) from the community. We genotyped unrelated Caucasians (n=5,366) and East Asians (n=989) using Illumina HumanCoreExome beadchips. CNV were called using three algorithms: iPattern (ipn), PennCNV (pcnv), and QuantiSNP (qsnp) and a high confidence dataset was generated by retaining variants detected by two or more algorithms and at least 10kb in size. We defined rare variants as those with less than 0.1% frequency against our population controls. We plan to examine whether CNV burden, overall and within psychiatrically relevant gene sets (e.g., brain expression, brain development), is associated with ADHD and OCD traits. We will also test if individual CNVs are associated with ADHD and OCD traits. Results After stringent quality control, 4857 (90.5%) Caucasian and 933 (94.3%) East Asian samples remained. Total number of CNVs was 31,798 with a mean size of 117,316 base pairs and a maximum size of 7.1 MB. The average number of CNVs per participants was 6. We uncovered 9,836 rare variants, of which 4,151 are deletions and 5,687 are duplications. This comprises of 7,613 rare CNVs from European subjects (mean size = 139,856 kb) and 2,225 from Asian individuals (mean size =123,141 kb). This represented a mean of 1.57 and 2.38 rare CNVs per individuals, respectively. We identified a total of 15 different known genomic disorders from 41 subjects (0.7%) in this cohort. Quantitative trait results forthcoming. Discussion Our novel approach will help elucidate the rate of psychiatrically relevant CNVs in the general population and the association of these CNVs with ADHD and OCD. Our preliminary data shows the feasibility of CNV analysis and quality of CNV data from the HumanCoreExome array in a large population based sample. Financial Relationships I (or my spouse/partner) do have potential conflicts of interest to disclose.

Chromosomal microarray analysis to assess copy-number variation has become a first-tier genetic diagnostic test for individuals with unexplained neurodevelopmental disorders or multiple congenital anomalies. More than 100 cytogenetic laboratories worldwide use the new ultra-high resolution Affymetrix CytoScan-HD array to genotype hundreds of thousands of samples per year. Our aim was to develop a copy-number variation resource from a new population sample that would enable more accurate interpretation of clinical genetics data on this microarray platform and others. Genotyping of 1,000 adult volunteers who are broadly representative of the Ontario population (as obtained from the Ontario Population Genomics Platform) was performed with the CytoScan-HD microarray system, which has 2.7 million probes. Four independent algorithms were applied to detect copy-number variations. Reproducibility and validation metrics were quantified using sample replicates and quantitative-polymerase chain reaction, respectively. DNA from 873 individuals passed quality control and we identified 71,178 copy-number variations (81 copy-number variations/individual); 9.8% (6,984) of these copy-number variations were previously unreported. After applying three layers of filtering criteria, from our highest confidence copy-number variation data set we obtained >95% reproducibility and >90% validation rates (73% of these copy-number variations overlapped at least one gene). The genotype data and annotated copy-number variations for this largely Caucasian population will represent a valuable public resource enabling clinical genetics research and diagnostics. Genet Med 17 9, 747–752.

Rare copy number variants (CNVs) disrupting ASTN2 or both ASTN2 and TRIM32 have been reported at 9q33.1 by genome-wide studies in a few individuals with neurodevelopmental disorders (NDDs). The vertebrate-specific astrotactins, ASTN2 and its paralog ASTN1, have key roles in glial-guided neuronal migration during brain development. To determine the prevalence of astrotactin mutations and delineate their associated phenotypic spectrum, we screened ASTN2/TRIM32 and ASTN1 (1q25.2) for exonic CNVs in clinical microarray data from 89 985 individuals across 10 sites, including 64 114 NDD subjects. In this clinical dataset, we identified 46 deletions and 12 duplications affecting ASTN2. Deletions of ASTN1 were much rarer. Deletions near the 3' terminus of ASTN2, which would disrupt all transcript isoforms (a subset of these deletions also included TRIM32), were significantly enriched in the NDD subjects (P = 0.002) compared with 44 085 population-based controls. Frequent phenotypes observed in individuals with such deletions include autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), speech delay, anxiety and obsessive compulsive disorder (OCD). The 3'-terminal ASTN2 deletions were significantly enriched compared with controls in males with NDDs, but not in females. Upon quantifying ASTN2 human brain RNA, we observed shorter isoforms expressed from an alternative transcription start site of recent evolutionary origin near the 3' end. Spatiotemporal expression profiling in the human brain revealed consistently high ASTN1 expression while ASTN2 expression peaked in the early embryonic neocortex and postnatal cerebellar cortex. Our findings shed new light on the role of the astrotactins in psychopathology and their interplay in human neurodevelopment.

De novo mutations (DNMs) are important in autism spectrum disorder (ASD), but so far analyses have mainly been on the ~1.5% of the genome encoding genes. Here, we performed whole-genome sequencing (WGS) of 200 ASD parent–child trios and characterised germline and somatic DNMs. We confirmed that the majority of germline DNMs (75.6%) originated from the father, and these increased significantly with paternal age only (P=4.2×10−10). However, when clustered DNMs (those within 20 kb) were found in ASD, not only did they mostly originate from the mother (P=7.7×10−13), but they could also be found adjacent to de novo copy number variations where the mutation rate was significantly elevated (P=2.4×10−24). By comparing with DNMs detected in controls, we found a significant enrichment of predicted damaging DNMs in ASD cases (P=8.0×10−9; odds ratio=1.84), of which 15.6% (P=4.3×10−3) and 22.5% (P=7.0×10−5) were non-coding or genic non-coding, respectively. The non-coding elements most enriched for DNM were untranslated regions of genes, regulatory sequences involved in exon-skipping and DNase I hypersensitive regions. Using microarrays and a novel outlier detection test, we also found aberrant methylation profiles in 2/185 (1.1%) of ASD cases. These same individuals carried independently identified DNMs in the ASD-risk and epigenetic genes DNMT3A and ADNP. Our data begins to characterize different genome-wide DNMs, and highlight the contribution of non-coding variants, to the aetiology of ASD.

Background There are four known pericentromeric euchromatic variants of chromosome 9 in the literature that are increasingly being observed in diagnostic cytogenetic laboratories. These variants pose diagnostic and counselling dilemmas, especially in prenatal settings, as distinction of a pathogenic alteration from a euchromatic variant is difficult. The molecular characterisation of three of these four variants has been reported. In this study, the genomic structure of the fourth variant, an additional G-positive band at 9q13-q21, is characterised. Methods Two unrelated families with the 9q13-q21 duplication variant, and a third individual with a cytogenetically visible 9q13-q21 deletion, were studied using conventional and molecular cytogenetics techniques, as well as microarrays. The highly repetitive nature of the segmental duplications in the region also necessitated the use of both interphase and metaphase fluorescence in situ hybridisation (FISH). Results It was determined that the DNA that constitutes this variant was ∼15–20 megabases in size and tandemly repeated as 3–4 cassettes of intrachromosomal segmental duplication. The variant appeared constitutively similar in sequence content and organisation between the two unrelated individuals, and it was inherited without apparent change. Sequences found amplified in the two duplication carriers were absent in the carrier of the deletion variant. Conclusions The sequences involved in both the 9q13-q21 duplication and deletion appear the same, implying reciprocity and suggesting non-allelic homologous recombination as the underlying mechanism. All four known euchromatic variants of chromosome 9 have now been shown to encompass segmental duplications. Importantly, a set of validated FISH probes was defined for the detection and characterisation of this 9q13-q21 amplification in the context of other chromosome 9 variants, allowing apparently benign variants to be distinguished from pathogenic changes.

The term monoclonal B-cell lymphocytosis (MBL) is used to characterize individuals with a circulating population of clonal B-cells and no other features of a lymphoproliferative disorder. Although several recent studies have examined the molecular basis of this condition, the subgroup of MBL lacking CD5 expression has been largely overlooked. In this study, we sequenced a t(2;7) in a patient with persistent but non-progressing CD5 − MBL. This revealed a breakpoint at 2p11.2 localized to the recombination signal sequence (RSS) of the immunoglobulin κ ( IGK ) variable gene IGKV3-15 , and a breakpoint at 7q21.2 located 520 base pairs (bp) upstream of the transcription start site of cyclin-dependent kinase 6 ( CDK6 ). The 7q breakpoint showed perfect sequence homology to the immunoglobulin RSS heptamer, and was located within 3 bp of a t(2;7) junction previously characterized in splenic marginal zone lymphoma (SMZL). These findings highlight a genetic link between CD5 − MBL and SMZL, and implicate the dysregulation of CDK6 in the emergence of this preclinical disorder.

Background Neoplasia can be driven by mutations resulting in dysregulation of transcription. In the mesenchymal neoplasm, aggressive fibromatosis, subtractive hybridization identified sterile alpha motif domain 9 (SAMD9) as a substantially down regulated gene in neoplasia. SAMD9 was recently found to be mutated in normophosphatemic familial tumoral calcinosis. In this study, we studied the gene structure and function of SAMD9, and its paralogous gene, SAMD9L, and examined these in a variety of species. Results SAMD9 is located on human chromosome 7q21.2 with a paralogous gene sterile alpha motif domain 9 like (SAMD9L) in the head-to-tail orientation. Although both genes are present in a variety of species, the orthologue for SAMD9 is lost in the mouse lineage due to a unique genomic rearrangement. Both SAMD9 and SAMD9L are ubiquitously expressed in human tissues. SAMD9 is expressed at a lower level in a variety of neoplasms associated with β-catenin stabilization, such as aggressive fibromatosis, breast, and colon cancers. SAMD9 and SAMD9L contain an amino-terminal SAM domain, but the remainder of the predicted protein structure does not exhibit substantial homology to other known protein motifs. The putative protein product of SAMD9 localizes to the cytoplasm. In vitro data shows that SAMD9 negatively regulates cell proliferation. Over expression of SAMD9 in the colon cancer cell line, SW480, reduces the volume of tumors formed when transplanted into immune-deficient mice. Conclusion SAMD9 and SAMD9L are a novel family of genes, which play a role regulating cell proliferation and suppressing the neoplastic phenotype. This is the first report as far as we know about a human gene that exists in rat, but is lost in mouse, due to a mouse specific rearrangement, resulting in the loss of the SAMD9 gene.

7 páginas, 2 figuras, 1 tabla., We have identified C7orf11, which localizes to the nucleus and is expressed in fetal hair follicles, as the first disease gene for nonphotosensitive trichothiodystrophy (TTD). C7orf11 maps to chromosome 7p14, and the disease locus has been designated “TTDN1” (TTDnonphotosensitive 1). Mutations were found in patients with Amish brittle-hair syndrome and in other nonphotosensititive TTD cases with mental retardation and decreased fertility but not in patients with Sabinas syndrome or Pollitt syndrome. Therefore, genetic heterogeneity in nonphotosensitive TTD is a feature similar to that observed in photosensitive TTD, which is caused by mutations in transcription factor II H (TFIIH) subunit genes. Comparative immunofluorescence analysis, however, suggests that C7orf11 does not influence TFIIH directly. Given the absence of cutaneous photosensitivity in the patients with C7orf11 mutations, together with the protein’s nuclear localization, C7orf11 may be involved in transcription but not DNA repair., We acknowledge The Centre for Applied Genomics, the Genome Canada/Ontario Genome Institute, the Hospital for Sick Children Foundation, the Association Française contre les Myopathies, and the Dykstra Foundation in Detroit (grant to C.E.J.). S.W.S. is an Investigator of the Canadian Institutes of Health Research, a Scholar of the McLaughlin Centre for Molecular Medicine, and an International Scholar of the Howard Hughes Medical Institute.

Objective To develop a novel clinical test using microarray technology as a high-resolution alternative to current methods for detection of known and novel microdeletions on the Y chromosome. Design Custom Agilent 8x15K array comparative genomic hybridization (aCGH) with 10,162 probes on an average probe spacing of 2.5 kb across the euchromatic region of the Y chromosome. Setting Clinical diagnostic laboratory. Patient(s) Men with infertility (n = 104) and controls with proven fertility (n = 148). Intervention(s) Microarray genotyping of DNA. Main Outcome Measure(s) Gene copy number variation determined by log ratio of probe signal intensity against a DNA reference. Result(s) Our aCGH experiments found all known AZF microdeletions as well as additional unbalanced structural alterations. In addition to complete AZF microdeletions, we found that AZFc partial deletions represent a risk factor for male infertility. In total, aCGH-based detection achieved a diagnostic yield of ∼11% and also revealed additional potentially etiologic copy number variations requiring further characterization. Conclusion(s) The aCGH approach is a reliable high-resolution alternative to multiplex polymerase chain reaction for the discovery of pathogenic chromosome Y microdeletions in male infertility.

Abstract 1191 Efforts to decipher the biological basis of lymphoid malignancy have recently been accentuated by the discovery of clonal B-cells in otherwise healthy individuals, an entity now referred to as monoclonal B-cell lymphocytosis (MBL). However, while considerable attention has been devoted towards characterizing this pervasive condition, the subgroup of MBL lacking CD5 expression has been largely overlooked. To address this imbalance, our group previously examined a series of cases presenting with persistent but non-progressing CD5- clonal lymphocytosis (Amato D et al, Am J Clin Pathol 2007). Herein, karyotypic analysis revealed a unique case harboring the translocation t(2;7)(p11;q22), a genetic abnormality which has been documented in association with splenic marginal zone lymphoma (SMZL). The present study set out to further characterize the t(2;7) breakpoint of this novel case study in order to test whether the translocation represents a common genetic link between CD5- MBL and SMZL. Using fluorescent in situ hybridization (FISH), the breakpoint on chromosome 7 was initially narrowed down to a 41 kilobase (kb) candidate region at 7q21.2, as inferred by a split signal from the cosmid probe cos130a6. Based on the proximity of the chromosome 2 breakpoint to the immunoglobulin kappa (IGK) locus on 2p11, long-range polymerase chain reaction (L-PCR) was subsequently performed according to the hypothesis that the t(2;7) translocation had arisen from aberrant VJ recombination. Primers targeting conserved sequences within the IGK variable genes were sequentially juxtaposed with primers on chromosome 7 located at 6 kb intervals across the 41 kb candidate region, and L-PCR conducted using both patient and reference DNA as a template. This process gave rise to a single instance of strong patient-specific amplification, thereby indicating successful targeting of the t(2;7) breakpoint. Sanger sequencing of the corresponding PCR product confirmed this result, revealing a breakpoint at 2p11.2 localized to the heptamer recombination signal sequence (RSS) of the IGK variable gene V3-15, alongside a breakpoint at 7q21.2 located 3.6 kb upstream of the transcription start site of the cell cycle regulator cyclin dependent kinase 6 (CDK6). Remarkably, the breakpoint on chromosome 7 showed perfect sequence homology to the immunoglobulin RSS heptamer, and was within 3 base pairs of a breakpoint previously characterized in association with SMZL (Corcoran M et al, Oncogene 1999). Hence, this result implicates the dysregulation of CDK6 during the clonal expansion observed in CD5- MBL, and highlights the potential role of aberrant VJ recombination during the formation of this genetic abnormality. By establishing a clear genetic link between CD5- MBL and SMZL, this study supports the notion of CD5- MBL as a precursor of overt malignancy within a ‘multi-hit’ model of oncogenesis. Finally, the sequence-level characterization of a novel translocation breakpoint by L-PCR strongly validates the potential utility of this approach during future studies of immunoglobulin-associated translocations. Disclosures: No relevant conflicts of interest to declare.

In 4 1/2 years (July 1973 to December 1977), 28 thoracotomies were performed by emergency physicians in the emergency department of a 540-bed community hospital, which averaged 25,800 visits per year. Two patients had sustained crush injuries of the chest in traffic accidents, and 26 had penetrating chest and/or abdominal trauma. Twenty-three of the patients had no vital signs and were clinically dead on arrival. Of these, four (17%) were resuscitated and transported to the operating room; three (13%) were long-term survivors and two left the hospital with no serious sequelae. The other five patients arrived with some vital signs but subsequently had cardiopulmonary arrests in the emergency department. Three (60%) were initially resuscitated using thoracotomy and transported to the operating room but there were no long-term survivors among this group of five. Of the 28 patients who underwent thoracotomies in the emergency department, one in four (7/28; 25%) were initially resuscitated, and one in nine (3/28; 11%) were long-term survivors. Thoracotomy in a community hospital emergency department by emergency physicians can be life-saving.

This study compares two similar groups of patients in cardiopulmonary arrest with ventricular fibrillation (VF). In the survival study group of 296 patients, 148 patients received an endotracheal tube airway (ETA) and 148 patients received an esophageal gastric tube airway (EGTA), the improved version of the esophageal obturator airway (EOA). Survival rates, both short term (ETA = 35.8%, EGTA = 39.1%) and long term (ETA = 11.5%, EGTA = 16.2%), and neurological sequelae of survivors showed no statistically significant difference between the two groups (P greater than .05). In addition, we found that success and complication rates of intubation were similar. Training time was longer for the ETA. We conclude that both airways have a place in the prehospital setting.

Widespread utilization of angiography has allowed discovery of fibromuscular hyperplasia affecting medium-sized arteries throughout the body. Such arterial dysplasia of the carotid and vertebral arteries is rare. However, as experience accumulates, it is becoming increasingly evident that this may be an important entity in these locations. Its significance derives from the fact that it may produce cerebral ischemia or infarction in persons of any age. The fact that this condition is frequently associated with intracerebral aneurysms and with fibromuscular hyperplasia of the renal artery suggests that it is a generalized arterial abnormality of common etiology. This communication details the clinical aspects of five patients with fibromuscular hyperplasia of the carotid and vertebral arteries. In one instance, this condition affected the vertebral arteries, in three, the carotids alone, and one, both the carotids and the vertebrals. The object of this presentation is to emphasize the diverse symptomatology, the association with other