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Purpose: Brain monoamine vesicular transport disease is an infantile-onset movement disorder that mimics cerebral palsy. In 2013, the homozygous SLC18A2 variant, p.Pro387Leu, was first reported as a cause of this rare disorder, and dopamine agonists were efficient for treating affected individuals from a single large family. To date, only 6 variants have been reported. In this study, we evaluated genotype–phenotype correlations in individuals with biallelic SLC18A2 variants. Methods: A total of 42 affected individuals with homozygous SLC18A2 variant alleles were identified. We evaluated genotype–phenotype correlations and the missense variants in the affected individuals based on the structural modeling of rat VMAT2 encoded by Slc18a2, with cytoplasm- and lumen-facing conformations. A Caenorhabditis elegans model was created for functional studies. Results: A total of 19 homozygous SLC18A2 variants, including 3 recurrent variants, were identified using exome sequencing. The affected individuals typically showed global developmental delay, hypotonia, dystonia, oculogyric crisis, and autonomic nervous system involvement (temperature dysregulation/sweating, hypersalivation, and gastrointestinal dysmotility). Among the 58 affected individuals described to date, 16 (28%) died before the age of 13 years. Of the 17 patients with p.Pro237His, 9 died, whereas all 14 patients with p.Pro387Leu survived. Although a dopamine agonist mildly improved the disease symptoms in 18 of 21 patients (86%), some affected individuals with p.Ile43Phe and p.Pro387Leu showed milder phenotypes and presented prolonged survival even without treatment. The C. elegans model showed behavioral abnormalities. Conclusion: These data expand the phenotypic and genotypic spectra of SLC18A2-related disorders. © 2022 American College of Medical Genetics and Genomics, National Institutes of Health, NIH: T32 GM007526-42; National Heart, Lung, and Blood Institute, NHLBI; National Human Genome Research Institute, NHGRI: K08 HG008986; National Institute of Neurological Disorders and Stroke, NINDS: R35NS105078; International Rett Syndrome Foundation, IRSF: 3701-1; Muscular Dystrophy Association, MDA: 512848; American Brain Foundation, ABF; American Academy of Neurology, AAN; Takeda Science Foundation, TSF; Japan Agency for Medical Research and Development, AMED: JP22ek0109486, JP22ek0109493, JP22ek0109549; Horizon 2020 Framework Programme, H2020; Muscular Dystrophy UK, MDUK; Multiple System Atrophy Trust, MSAT; Brain Research UK, BRUK; Baylor-Hopkins Center for Mendelian Genomics, BHCMG: UM1 HG006542; Medical Research Council, MRC: G0601943, MR/S005021/1, MR/S01165X/1; Ataxia UK; European Research Council, ERC; Rosetrees Trust; Great Ormond Street Hospital Charity, GOSH; Japan Society for the Promotion of Science, KAKEN: JP19H03621, JP20K07907, JP20K08164, JP20K16932, JP20K17936, JP21k15907; Horizon 2020: 714853, MC-A658-5TY30; University College London Hospitals Biomedical Research Centre, UCLH BRC; King Salman Center for Disability Research, KSCDR: RG-2022-010, We thank the participants and their families for their involvement in this study. This work was supported by the Japan Agency for Medical Research and Development ( AMED ) under grant numbers JP22ek0109486, JP22ek0109549, and JP22ek0109493 (N.Ma.); Japan Society for the Promotion of Science ( JSPS) KAKENHI under grant numbers JP19H03621 (N.Mi.), JP20K07907 (S.M.), JP20K08164 (T.Miz.), JP20K17936 (A.F.), JP20K16932 (K.H.), and JP21k15907 (Y.U.); and the Takeda Science Foundation (T.Miz., N.Mi., and N.Ma.). This study was partially supported by the US National Human Genome Research Institute and National Heart Lung and Blood Institute to the Baylor-Hopkins Center for Mendelian Genomics (UM1 HG006542 to J.R.L.), US National Institute of Neurological Disorders and Stroke (R35NS105078 to J.R.L.), and Muscular Dystrophy Association (512848 to J.R.L.). D.Ma. was supported by a Medical Genetics Research Fellowship Program through the National Institutes of Health (T32 GM007526-42). D.P. was supported by a Clinical Research Training Scholarship in Neuromuscular Disease partnered by the American Academy of Neurology , American Brain Foundation , and Muscle Study Group and by the International Rett Syndrome Foundation (grant number #3701-1). J.E.P. was supported by the National Human Genome Research Institute (K08 HG008986). H.H. was funded by the Medical Research Council ( MRC) (MR/S01165X/1, MR/S005021/1, and G0601943), NIHR University College London Hospitals Biomedical Research Centre , Rosetree Trust, Ataxia UK , Multiple System Atrophy Trust , Brain Research UK , Sparks Great Ormond Street Hospital Charity , Muscular Dystrophy UK , and Muscular Dystrophy Association . N.D. was supported by an MRC strategic award to establish International Centre for Genomic Medicine in Neuromuscular Diseases (MR/S005021/1). This project also received funding from the European Research Council under the European Union’s Horizon 2020 Research and Innovation Program (grant agreement number 714853) and was supported by the Medical Research Council through grant MC-A658-5TY30. We acknowledge the support of King Salman Center for Disability Research through Research Group no RG-2022-010 (F.S.A.). Figure 1A, 2A, and Graphical Abstract were created with BioRender.com ., We thank the participants and their families for their involvement in this study. This work was supported by the Japan Agency for Medical Research and Development (AMED) under grant numbers JP22ek0109486, JP22ek0109549, and JP22ek0109493 (N.Ma.); Japan Society for the Promotion of Science (JSPS) KAKENHI under grant numbers JP19H03621 (N.Mi.), JP20K07907 (S.M.), JP20K08164 (T.Miz.), JP20K17936 (A.F.), JP20K16932 (K.H.), and JP21k15907 (Y.U.); and the Takeda Science Foundation (T.Miz., N.Mi., and N.Ma.). This study was partially supported by the US National Human Genome Research Institute and National Heart Lung and Blood Institute to the Baylor-Hopkins Center for Mendelian Genomics (UM1 HG006542 to J.R.L.), US National Institute of Neurological Disorders and Stroke (R35NS105078 to J.R.L.), and Muscular Dystrophy Association (512848 to J.R.L.). D.Ma. was supported by a Medical Genetics Research Fellowship Program through the National Institutes of Health (T32 GM007526-42). D.P. was supported by a Clinical Research Training Scholarship in Neuromuscular Disease partnered by the American Academy of Neurology, American Brain Foundation, and Muscle Study Group and by the International Rett Syndrome Foundation (grant number #3701-1). J.E.P. was supported by the National Human Genome Research Institute (K08 HG008986). H.H. was funded by the Medical Research Council (MRC) (MR/S01165X/1, MR/S005021/1, and G0601943), NIHR University College London Hospitals Biomedical Research Centre, Rosetree Trust, Ataxia UK, Multiple System Atrophy Trust, Brain Research UK, Sparks Great Ormond Street Hospital Charity, Muscular Dystrophy UK, and Muscular Dystrophy Association. N.D. was supported by an MRC strategic award to establish International Centre for Genomic Medicine in Neuromuscular Diseases (MR/S005021/1). This project also received funding from the European Research Council under the European Union's Horizon 2020 Research and Innovation Program (grant agreement number 714853) and was supported by the Medical Research Council through grant MC-A658-5TY30. We acknowledge the support of King Salman Center for Disability Research through Research Group no RG-2022-010 (F.S.A.). Figure 1A, 2A, and Graphical Abstract were created with BioRender.com.

Made available in DSpace on 2022-04-29T08:46:40Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-12-01 National Institute of General Medical Sciences As whole-genome sequencing (WGS) becomes the gold standard tool for studying population genomics and medical applications, data on diverse non-European and admixed individuals are still scarce. Here, we present a high-coverage WGS dataset of 1,171 highly admixed elderly Brazilians from a census-based cohort, providing over 76 million variants, of which ~2 million are absent from large public databases. WGS enables identification of ~2,000 previously undescribed mobile element insertions without previous description, nearly 5 Mb of genomic segments absent from the human genome reference, and over 140 alleles from HLA genes absent from public resources. We reclassify and curate pathogenicity assertions for nearly four hundred variants in genes associated with dominantly-inherited Mendelian disorders and calculate the incidence for selected recessive disorders, demonstrating the clinical usefulness of the present study. Finally, we observe that whole-genome and HLA imputation could be significantly improved compared to available datasets since rare variation represents the largest proportion of input from WGS. These results demonstrate that even smaller sample sizes of underrepresented populations bring relevant data for genomic studies, especially when exploring analyses allowed only by WGS. Human Genome and Stem Cell Research Center University of São Paulo, SP Department of Genetics and Evolutionary Biology Biosciences Institute University of São Paulo, SP Hospital Israelita Albert Einstein, SP Instituto da Criança Faculdade de Medicina da Universidade de São Paulo, SP Orthopedic Research Labs Boston Children’s Hospital and Department of Genetics Harvard Medical School Laboratório DASA Laboratory of Genome Structure and Ageing European Research Institute for the Biology of Ageing University Medical Center Groningen São Paulo State University (UNESP) Molecular Genetics and Bioinformatics Laboratory School of Medicine, State of São Paulo São Paulo State University (UNESP) Department of Pathology School of Medicine, State of São Paulo Departamento de Química Faculdade de Filosofia Ciências e Letras de Ribeirão Preto Universidade de São Paulo, São Paulo Centro de Oncologia Molecular Hospital Sirio-Libanes Department of Biochemistry Institute of Chemistry University of São Paulo São Paulo Bioinformatics Graduate program University of São Paulo Departamento de Genética Ecologia e Evolução Instituto de Ciências Biológicas Universidade Federal de Minas Gerais, MG Núcleo de Ensino e Pesquisa Instituto Mário Penna, MG Laboratorio de Biotecnologia y Biologia Molecular Instituto Nacional de Salud Universidad de Huánuco Division of Cancer Epidemiology and Genetics National Cancer Institute Instituto de Saúde Coletiva Universidade Federal da Bahia, BA Center for Data and Knowledge Integration for Health Institute Gonçalo Muniz Fundação Oswaldo Cruz, BA Instituto de Pesquisas René Rachou Fundação Oswaldo Cruz, MG Programa De Pós-Graduação em Saúde Pública Universidade Federal de Minas Gerais, MG Programa de Pós-Graduação em Epidemiologia Universidade Federal de Pelotas, RS Mosaico Translational Genomics Initiative Universidade Federal de Minas Gerais, MG Facultad de Salud Pública y Administración Universidad Peruana Cayetano Heredia Instituto de Estudos Avançados Transdisciplinares Universidade Federal de Minas Gerais, MG Medical-Surgical Nursing Department School of Nursing University of São Paulo, SP Epidemiology Department Public Health School University of São Paulo, SP São Paulo State University (UNESP) Molecular Genetics and Bioinformatics Laboratory School of Medicine, State of São Paulo São Paulo State University (UNESP) Department of Pathology School of Medicine, State of São Paulo National Institute of General Medical Sciences: R01 GM075091

Identification of genetic causes of primary monogenic immunodeficiencies would strengthen the current understanding of their immunopathology. Pathogenic variants in genes in association with tumor necrosis factor α (TNFα) signaling, including OTULIN, TNFAIP3, RBCK1, and RNF31 cause human congenital autoinflammatory diseases with/without immunodeficiency. RIPK1, encoding a receptor interacting serine/threonine kinase 1, is present in protein complexes mediating signal transduction including TNF receptor 1. Biallelic loss-of-function variants in RIPK1 were recently reported in individuals with primary immunodeficiency with intestinal bowel disease and arthritis. Here, we report a novel homozygous RIPK1 variant in a boy with immunodeficiency and chronic enteropathy. Our patient exhibited severe motor delay and mild intellectual disability, which were previously unknown. The present results are expected to deepen the current understanding of clinical features based on RIPK1 abnormalities.

The present study aims to provide orientation for clinicians and radiologists to recognize the most prevalent findings leading to diagnosis in mucolipidosis from a description of the natural history of five Brazilian cases. We conducted an observational and retrospective study of five patients with clinical and radiological diagnosis of mucolipidosis. Clinical evaluation consisted of information obtained from records and including physical, neurologic, and dysmorphic evaluations. Radiologic studies consisted of complete skeletal radiographs of all patients. Enzyme assessment was performed for confirmation of the diagnosis. The five patients were referred for genetic evaluation due to disproportionate short stature with short trunk accompanied by waddling gait. Age at referral varied from 11 months to 28 years. The most prevalent findings were joint restriction (4/5 patients), neuropsychomotor developmental delay (3/5), coarse facies (2/5), hypertrophic cardiomyopathy (2/5), and mental retardation (1/4 patients). The most common radiological findings were anterior beaking of the vertebral bodies (5/5), shallow acetabular fossae (5/5), epiphyseal dysplasia (5/5), platyspondyly (4/5), pelvic dysplasia (4/5), decreased bone mineralization (4/5), scoliosis (3/5), wide and oar-shaped ribs (3/5), generalized epiphyseal ossification delay (3/5), and hypoplasia of basilar portions of ilea (3/5). Enzyme assessment showed α-iduronidase, α-mannosidase, β-glucuronidase, hexosaminidase A, and total hexosaminidase increased in plasma and normal glycosaminoglycans concentration. One patient was clinically classified as ML II and four patients as ML III. The follow-up of five patients showed the typical clinical and radiological findings allowing the diagnosis, thus improving clinical management and providing adequate genetic counseling. Clinicians and radiologists can take advantage of the information from this work, enhancing their differential diagnosis ability.

Congenital limb deficiency (CLD), one of the most common congenital anomalies, is characterized by hypoplasia/aplasia of one or more limb bones and can be isolated or syndromic. The etiology in CLD is heterogeneous, including environmental and genetic factors. A fraction remains with no etiological factor identified. We report the study of 44 Brazilian individuals presenting isolated or syndromic CLD, mainly with longitudinal defects. Genetic investigation included particularly next-generation sequencing (NGS) and/or chromosomal microarray. The overall diagnostic yield was 45.7%, ranging from 60.9% in the syndromic to 16.7% in the non-syndromic group. In TAR syndrome, a common variant in 3´UTR of RBM8A, in trans with 1q21.1 microdeletion, was detected, corroborating the importance of this recently reported variant in individuals of African ancestry. NGS established a diagnosis in three individuals in syndromes recently reported or still under delineation (an acrofacial dysostosis, Coats plus and Verheij syndromes), suggesting a broader phenotypic spectrum in these disorders. Although a low rate of molecular detection in non-syndromic forms was observed, it is still possible that variants in non-coding regions and small CNVs, not detected by the techniques applied in this study, could play a role in the etiology of CLD.

We report the clinical and molecular data of a large cohort comprising 242 individuals with RASopathies, from a single Tertiary Center in Brazil, the largest study from Latin America. Noonan syndrome represented 76% of the subjects, with heterozygous variants in nine different genes, mainly PTPN11, SOS1, RAF1, LZTR1, and RIT1, detected by Sanger and next-generation sequencing. The latter was applied to 126 individuals, with a positive yield of 63% in genes of the RAS/MAPK cascade. We present evidence that there are some allelic differences in PTPN11 across distinct populations. We highlight the clinical aspects that pose more medical concerns, such as the cardiac anomalies, bleeding diathesis and proliferative lesions. The genotype-phenotype analysis between the RASopathies showed statistically significant differences in some cardinal features, such as craniofacial and cardiac anomalies, the latter also statistically significant for different genes in Noonan syndrome. We present two individuals with a Noonan syndrome phenotype, one with an atypical, structural cardiac defect, harboring variants in genes mainly associated with isolated hypertrophic cardiomyopathy and discuss the role of these variants in their phenotype.

Background Cri du chat syndrome (CdCS) is a rare syndrome caused by a partial or complete deletion of the short arm of chromosome 5 (5p‐). The main clinical features include a high‐pitched cry, facial asymmetry, microcephaly, round face at birth, epicanthal folds, hypotonia, delayed growth and development. Methods We studied 14 Brazilian patients with CdCS using genomic array in order to better define the 5p breakpoints and recognize copy number variations (CNVs) that contribute to clinical manifestations associated with the syndrome. Results Array confirmed terminal deletions in 13 patients and an interstitial deletion in one patient. It was also possible to map the breakpoints and associate a genomic region of 4.7 Mb to the development of head circumference and cat‐like cry. We also found other CNVs concomitant to the 5p deletion including a 9p duplication, a 17q deletion, and a 22q deletion in three different patients. Conclusion With advancements of molecular cytogenomic methods in the last two decades, it was possible to evidence cryptic alterations and improve the genotype–phenotype correlation. In this work, we describe a new genomic region associated with microcephaly and cat‐like cry and highlight the importance of precise delineation of 5p deletion breakpoints and detection of other CNVs in CdCS patients to improve genotype–phenotype correlation to perform a complete clinical and molecular diagnosis., We studied 14 Brazilian patients with Cri du chat syndrome using arrays and suggest a new genomic region associated with microcephaly and cat‐like cry. Also we highlight the importance of precise delineation of 5p deletion breakpoints for better genotype–phenotype correlation.

As whole-genome sequencing (WGS) becomes the gold standard tool for studying population genomics and medical applications, data on diverse non-European and admixed individuals are still scarce. Here, we present a high-coverage WGS dataset of 1,171 highly admixed elderly Brazilians from a census-based cohort, providing over 76 million variants, of which ~2 million are absent from large public databases. WGS enables identification of ~2,000 previously undescribed mobile element insertions without previous description, nearly 5 Mb of genomic segments absent from the human genome reference, and over 140 alleles from HLA genes absent from public resources. We reclassify and curate pathogenicity assertions for nearly four hundred variants in genes associated with dominantly-inherited Mendelian disorders and calculate the incidence for selected recessive disorders, demonstrating the clinical usefulness of the present study. Finally, we observe that whole-genome and HLA imputation could be significantly improved compared to available datasets since rare variation represents the largest proportion of input from WGS. These results demonstrate that even smaller sample sizes of underrepresented populations bring relevant data for genomic studies, especially when exploring analyses allowed only by WGS.

Epidermolysis bullosa describes a group of skin conditions caused by mutations in genes encoding proteins related to dermal-epidermal adhesion. In the United States, 50 cases of epidermolysis bullosa per 1 million live births are estimated, 92% of which classified as simplex, 5% dystrophic, 1% junctional and 2% non-classified. Dystrophic epidermolysis bullosa is associated with autosomal, dominant and recessive inheritance. Epidermolysis bullosa causes severe psychological, economic and social impacts, and there is currently no curative therapy, only symptom control. Embryonic selection is available for epidermolysis bullosa patients in order to prevent perpetuation of the condition in their offspring.

Pediatric hypertension can cause hypertensive emergencies, including hemorrhagic stroke, contributing to rare but serious childhood morbidity and mortality. Renovascular hypertension (RVH) is one of the major causes of secondary hypertension in children. Grange syndrome (MIM#602531) is a rare disease characterized by multiple stenosis or occlusion of the renal, abdominal, coronary, and cerebral arteries, which can cause phenotypes of RVH and fibromuscular dysplasia (MIM#135580). We report the case of a 7-year-old girl with Grange syndrome who showed RVH and multiple seizure episodes. At 1 year of age, she experienced seizures and sequential hemiparesis caused by a left thalamic hemorrhage without cerebral vascular anomalies. Chronic hypertension was observed, and abdominal computed tomography angiography showed characteristic bilateral renal artery stenosis. Whole-exome sequencing revealed a novel homozygous pathogenic variant in the YY1AP1 gene (NM_001198903.1: c.1169del: p.Lys390Argfs*12). Biallelic YY1AP1 mutations are known to cause Grange syndrome. Unlike previously reported patients, our patient presented with intracerebral hemorrhagic stroke without anomalous brain artery or bone fragility. The phenotype in our patient may help better understand this ultra-rare syndrome. Grange syndrome should be considered in patients presenting with childhood-onset hypertension and/or hemorrhagic stroke for early clinical intervention.

Genomic imbalances are the most common cause of congenital anomalies (CA) and intellectual disability (ID). The aims of this study were to identify copy number variations (CNVs) in 416 patients with CA and ID from 5 different genetics centers within 4 different states by using the Multiplex Ligation-dependent Probe Amplification (MLPA) technique and to apply the chromosomal microarray (CMA) methodology in selected cases. The samples were analyzed by MLPA kits P064, P036, P070 and P250. Positive results were found in 97/416 (23.3%) patients. CMA was applied in 14 selected cases. In 6/14 (42.85%) patients, CMA detected other copy number variations not detected by the MLPA studies. Although CMA is indispensable for genotype refinement, the technique is still unfeasible in some countries as a routine analysis due to economic and technical limitations. In these cases, clinical evaluation followed by karyotyping and MLPA analysis is a helpful and affordable solution for diagnostic purposes.

Mosaic trisomy 12 is a rare anomaly, and only 9 cases of live births with this condition have been reported in the literature. The clinical phenotype is variable, including neuropsychomotor developmental delay, congenital heart disease, microcephaly, cutaneous spots, facial asymmetry, prominent ears, hypotonia, retinopathy, and sensorineural hearing loss. A 2-year-old female presented with neuropsychomotor developmental delay, prominent forehead, dolichocephaly, patchy skin pigmentation, and unexpected overgrowth at birth. Cytogenetic analysis of her peripheral blood showed normal results, suggesting the presence of a chromosomal alteration in other tissues. Further studies using G-banding and FISH performed on fibroblasts from both hyper- and hypopigmented regions identified a 47,XX,+12/46,XX karyotype. To the best of our knowledge, no patients with mosaic trisomy 12 associated with overgrowth have been reported to date. Congenital overgrowth and neonatal overgrowth have been frequently linked to Pallister-Killian syndrome (PKS; OMIM 601803). This case suggests the possibility of an association of genes present in the 12p region with fetal overgrowth, considering that chromosomal duplications could lead to an increase in the production of aberrant transcripts and disturbing gene dosage effects. This case highlights the importance of cytogenetic analysis in different tissues to provide relevant information to the specific genotype/phenotype correlation.

OBJECTIVES: To characterize the natural history of 39 achondroplastic patients diagnosed by clinical, radiological and molecular assessments. METHODS: Observational and retrospective study of 39 patients who were attended at a public tertiary level hospital between 1995 and 2016. RESULTS: Diagnosis was made prenatally in 11 patients, at birth in 9 patients and within the first year of life in 13 patients. The most prevalent clinical findings were short stature, high forehead, trident hands, genu varum and macrocephaly. The most prevalent radiographic findings were rhizomelic shortening of the long bones and narrowing of the interpediculate distance of the caudal spine. There was motor developmental delay in 18 patients and speech delay in 16 patients. The most common clinical intercurrences were middle ear dysfunction, sleep apnea, limb pain and obesity from 2 to 9 years of age. One patient was large for the gestational age but did not develop obesity. One patient developed hydrocephalus at 10 years old. The current age of the patients varies from 15 months to 36 years. The molecular study performed by Sanger sequencing of the common heterozygous mutation 1138G>A in FGFR3 was positive in all patients. Four cases were inherited, and 35 were sporadic (paternal age from 19 to 66 years). CONCLUSIONS: The diagnoses were made early based on clinical and radiographic findings. All cases were confirmed molecularly. Despite presenting a benign course, it is necessary to establish a systematic protocol for the surveillance of these patients due to the common clinical intercurrences.

CHIME syndrome is an extremely rare autosomal recessive multisystemic disorder caused by mutations in PIGL. PIGL is an endoplasmic reticulum localized enzyme that catalyzes the second step of glycosylphosphatidylinositol (GPI) biosynthesis, which plays a role in the anchorage of cell-surface proteins including receptors, enzymes, and adhesion molecules. Germline mutations in other members of GPI and Post GPI Attachment to Proteins (PGAP) family genes have been described and constitute a group of diseases within the congenital disorders of glycosylation. Patients in this group often present alkaline phosphatase serum levels abnormalities and neurological symptoms. We report a CHIME syndrome patient who harbors a missense mutation c.500T > C (p.Leu167Pro) and a large deletion involving the 5’ untranslated region and part of exon 1 of PIGL. In CHIME syndrome, a recurrent missense mutation c.500T > C (p.Leu167Pro) is found in the majority of patients, associated with a null mutation in the other allele, including an overrepresentation of large deletions. The latter are not detected by the standard analysis in sequencing techniques, including next-generation sequencing. Thus, in individuals with a clinical diagnosis of CHIME syndrome in which only one mutation is found, an active search for a large deletion should be sought.

This case report describes a 30-year-old female patient, carrier of a balanced chromosomal translocation. The patient has a past of three consecutives abortions, the first two losses during the tenth week of pregnancy and the third during the eighth week. This situation motivated the couple to seek the obstetrics & gynecologic professional at the Basic Health Care Unit, who referred them to the Genetic ambulatory care. Karyotype reveals the female patient carries a balanced chromosomal translocation, being 46,XX, t(1;16)(p36;q22), while her partner is normal 46,XY. Such chromosomal abnormality is largely linked with recurrent miscarriage in early pregnancy and the risk of birth of an abnormal child, therefore it is recommended genetic counseling and assisted reproduction if another pregnancy is desired.