Hana Flögelová, Marijan Saraga, Maria Szczepańska, John M Darlow, Nicholas Katsanis, Barry Honig, Donald Petrey, Ali Samii, Akira Imamoto, Adele Mitrotti, Vladimir J Lozanovski, Bradley A. Warady, Max Werth, Qingxue Liu, Susan L. Furth, Mirna Saraga-Babić, Silvia E. Racedo, Grażyna Krzemień, Yangfan P. Liu, Rik Westland, Christopher E. Gillies, Iain A. Drummond, Alba Carrea, Matthew G. Sampson, Nicholas J Steers, Rémi Salomon, Rong Deng, Valentina P Capone, V. D’Agati, Virginia E. Papaioannou, Richard P. Lifton, Katarina Vukojević, Claudia Izzi, Małgorzata Mizerska-Wasiak, Francesco Scolari, Marcin Tkaczyk, Joanna A.E. van Wijk, Gabriel Makar, Prem Puri, Esther Lopez-Rivera, Loreto Gesualdo, Bernice E. Morrow, Jonathan Barasch, Velibor Tasic, Marcin Zaniew, Cécile Jeanpierre, Adela Arapović, Asaf Vivante, Donna M. McDonald-McGinn, Terrence B. Crowley, Monica Bodria, Daniele Cusi, Wassila Carpentier, Craig S. Wong, Ali G. Gharavi, Miguel Verbitsky, David Fasel, Zhonghai Yan, Edgar A. Otto, David E. Barton, Zoran Gucev, Monika Miklaszewska, Virginia Vega-Warner, Dorota Drozdz, Jeremiah Martino, Elaine H. Zackai, Agnieszka Szmigielska, Anna Latos-Bielenska, Mariarosa Maiorana, Anna Materna-Kiryluk, Landino Allegri, Dominique Gaillard, Laurence Heidet, Friedhelm Hildebrandt, Hakon Hakonarson, Gian Marco Ghiggeri, Simone Sanna-Cherchi, Nenad Kunac, Przemysław Sikora, Emilio Casolari, Krzysztof Kiryluk, Blair R. Anderson, Pediatric surgery, ACS - Microcirculation, Amsterdam Reproduction & Development (AR&D), Plateforme Post-génomique de la Pitié-Salpêtrière (P3S), UMS omique (OMIQUE), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie (UPMC), and Université Pierre et Marie Curie - Paris 6 (UPMC)
International audience; Background: The DiGeorge syndrome, the most common of the microdeletion syndromes, affects multiple organs, including the heart, the nervous system, and the kidney. It is caused by deletions on chromosome 22q11.2; the genetic driver of the kidney defects is unknown.Methods: We conducted a genomewide search for structural variants in two cohorts: 2080 patients with congenital kidney and urinary tract anomalies and 22,094 controls. We performed exome and targeted resequencing in samples obtained from 586 additional patients with congenital kidney anomalies. We also carried out functional studies using zebrafish and mice.Results: We identified heterozygous deletions of 22q11.2 in 1.1% of the patients with congenital kidney anomalies and in 0.01% of population controls (odds ratio, 81.5; P=4.5×10-14). We localized the main drivers of renal disease in the DiGeorge syndrome to a 370-kb region containing nine genes. In zebrafish embryos, an induced loss of function in snap29, aifm3, and crkl resulted in renal defects; the loss of crkl alone was sufficient to induce defects. Five of 586 patients with congenital urinary anomalies had newly identified, heterozygous protein-altering variants, including a premature termination codon, in CRKL. The inactivation of Crkl in the mouse model induced developmental defects similar to those observed in patients with congenital urinary anomalies.Conclusions: We identified a recurrent 370-kb deletion at the 22q11.2 locus as a driver of kidney defects in the DiGeorge syndrome and in sporadic congenital kidney and urinary tract anomalies. Of the nine genes at this locus, SNAP29, AIFM3, and CRKL appear to be critical to the phenotype, with haploinsufficiency of CRKL emerging as the main genetic driver. (Funded by the National Institutes of Health and others.).