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Neurofibromatosis type 1 (NF1) is caused by mutations in the NF1 gene. This retrospective study aims to evaluate the clinical manifestations and brain magnetic resonance images (MRI) analysis in 60 genetically confirmed NF1 patients. The results of next-generation sequencing (NGS), Sanger sequencing, and MLPA of NF1 gene were evaluated. A total of 54 different variants were identified. Fourteen out of them were novel variants (25.9%). Patients who complied with NIH criteria had most frequently frameshift variants (11/32 patients), and those with only CALMs had missense variants (9/28 patients). Neurofibromatosis type 1 bright objects (NBOs) on T2-weighted MRI were detected in 42 patients (42/56; 75%). These brain lesions were detected mostly in basal ganglia and in cerebellar vermis. NBOs were detected more in the patients who complied with NIH criteria (80.6%) compared to those who were only CALMs (68%). While frameshift variants (33.3%) were the most common type variants in the patients who had NBOs, the most common variants were splicing (35.7%) and missense (35.7%) variants in the patients whose MRIs were normal. Frameshift variants (11/28 patients; 39.3%) were the most common in the patients with more than one brain locus involvement. Therefore, we consider that frameshift variants may be associated with increased incidence of NBOs and involvement of more than one brain locus. In addition, NBOs may occur less frequently in the patients with splicing variants. To our knowledge, this is the first study evaluated the relationship between NF1 gene variants and NBOs. Future studies may help us understand the etiology of NBOs.

Prader–Willi, Angelman, Beckwith–Wiedemann, and Russell–Silver are imprinting syndromes. In this study, we aimed to compare the efficiency of single nucleotide polymorphism (SNP) microarray analysis with methylation-specific Multiplex ligation-dependent probe amplification (MS-MLPA) in the detection of uniparental disomy in these syndromes. The patient samples with regions of loss of heterozygosity (LOH), covering 15q11.2 and 11p15.5 critical loci, were analyzed with MS-MLPA to demonstrate the efficiency of SNP microarray in the detection of uniparental disomy (UPD). In a total of seven patients, LOH covering 15q11.2 and 11p15.5 critical loci was detected. Two (28.6%) of these seven patients showed aberrant methylation (suggesting UPD) in MS-MLPA. SNP microarray is a useful tool in the detection of LOH; however, it should be used with caution, since false-positive or false-negative LOH results can be obtained. Although methylation analysis is recommended as the first tier test in the diagnosis of most of the imprinting disorders, combining methylation analysis with SNP microarray can enhance our evaluation process.

Objective The aim of this study is to investigate the efficiency of a first-line molecular genetic evaluation approach, in children with deafness. Methods Patients who were found to have sensorineural hearing loss by age-appropriate audiological tests were selected for the molecular genetic evaluation. The molecular genetic evaluation was carried out with GJB2 gene sequence analysis and mtDNA m.1555A>G mutation Restriction Fragment Length Polymorphism (RFLP) analysis. Additionally, in a small group of patients, hearing loss Multiplex Ligation-dependent Probe Amplification (MLPA) analysis was done out to identify the possible role of copy number changes. Results In this Turkish cohort, which included 104 index patients and 78 relatives, 33 (31.7%) had Pathogenic/Likely Pathogenic variants. One or more GJB2 sequence variants were identified in 46 (44.1%) of the 104 index patients. The homozygous c.35delG mutation by itself explained the etiology in 24% of our ARSNHL group. In one (5%) of the 20 patients of MLPA group, a hemizygous deletion in POU3F4 gene was detected. Conclusion In our Turkish cohort, we applied a first-line molecular genetic evaluation approach using GJB2 gene sequence analysis and mtDNA m.1555A>G RFLP analysis. This approach revealed the genetic etiology of 44.1% of our index patients. Additionaly, the results of hearing loss MLPA analysis revealed the limited role of copy number changes in this patient group. Furthermore, with a detailed genotype-phenotype association workup, 2 rare cases of Deafness with Palmoplantar Hyperkeratosis and Keratitis-Ichthyosis-Deafness syndrome were reported.

Introduction Limb-girdle muscular dystrophy (LGMD) is the fourth most common muscular dystrophy, with progressive proximal muscle weakness. However, a large number of neuromuscular conditions are similarly presented. Because of this, the use of high-throughput methods such as next-generation sequencing (NGS) is important in the evaluation of LGMD. Methods In this report, we applied a custom target capture-based NGS panel covering 31 LGMD-associated genes (MYOT, LMNA, CAV3, DES, DNAJB6, FLNC, CAPN3, DYSF, SGCG, SGCA, SGCB, SGCD, TCAP, TRIM32, FRKP, TTN, POMT1, ANO5, FKTN, POMT2, POMGnT1, DAG1, PLEC, GAA, GMPPB, HNRNPDL, TNPO3, LIMS2, POMK, TRAPPC11, ISPD) in 74 patients suspected of LGMD. Results In 25 (33.8%) out of 74 patients analyzed, one or more pathogenic/likely pathogenic variants in 13 different genes were detected. Six of the patients had the variants that were not found in databases and literature; thus, they were interpreted as novel pathogenic variants. Discussion The diagnosis rate achieved (33.8%) is consistent with previous literature reports and underlines the efficiency and importance of NGS technology in the molecular genetic evaluation of LGMD.

INTRODUCTION Brain metastasis prevalence is higher in patients with positive epidermal growth factor receptor (EGFR) mutation, anaplastic lymphoma kinase (ALK) and C-ROS oncogene 1 (ROS-1) fusion change in lung adenocarcinoma. OBJECTIVES The purpose of our study is to investigate the relation between the genetic change type and the initial distant metastasis in stage IV lung adenocarcinoma patients with genetic changes. METHODS The study was conducted between January 2007 and December 2018 in a retrospective fashion with patients who had lung cancer diagnosed as stage IV adenocarcinoma. The relation between genetic mutation change (EGFR, ALK or ROS-1) and distant metastasis was analysed. RESULTS A total of 845 patients were included in the study. The median age was 62 (28-88). It was determined that lung and pleura metastases were more frequent at a significant level in patients with positive EGFR mutation (P = 0.032, P = 0.004, respectively). In patients with positive ALK fusion change, pleura metastasis was determined to be more frequent (P = 0.001). Multiple metastases were determined to be significantly more in patients with positive ALK fusion change than single metastasis (P = 0.02). CONCLUSION In patients with EGFR mutant lung adenocarcinoma, lung and pleura metastasis is more frequent and pleura metastasis is more frequent in ALK positive adenocarcinoma. Additionally, multiple organ metastases are higher in ALK positive lung adenocarcinoma.

OBJECTIVE

Background Chromosomal microarray analysis is the first-tier test for the evaluation of developmental disabilities and congenital anomalies. In this report, we present CMA results of 971 patient and 301 parent samples. Materials and Methods Among 971 patient samples, 133 (13.6%) had pathogenic variants. Results While analyzing, an “in-house” variant database was also used besides other databases. Owing to this, we have found chance to report the most frequent benign variants in Turkish population. Conclusion With the additional data we acquired in this study, we also emphasized the high potential of CMA in revealing single gene disorders and novel gene-phenotype associations as well as copy number variations.

The aim of this study was to evaluate the maternal and foetal factors affect higher cell-free DNA (cfDNA) levels and to investigate a possible relationship between high cfDNA levels and adverse perinatal outcomes. From a total of 4594 women who underwent non-invasive prenatal testing from January 2016 to March 2018 in our hospital, 112 women had high levels of cfDNA, which was not appropriate for testing. Maternal characteristics and perinatal outcomes were compared between patients with high levels of cfDNA and normal levels of cfDNA. Patients with high levels of cfDNA had greater risks than patients with normal cfDNA levels of pregnancy complications but no statistically significant difference was found. Patients with high cfDNA levels had higher foetal death rates with a statistically significant difference (9.8% versus 1.8%, p = .024). An increase in foetal death could be expected in patients with increased cfDNA levels; therefore, these patients should be carefully followed up during pregnancy.IMPACT STATEMENT What's already known about this topic? Most studies about cfDNA levels are focussed on the foetal fraction. There are new arguments about maternal health and cfDNA. It is known that autoimmune diseases as systemic lupus erythematosus (SLE) and maternal obesity increase cell turnover. There are also clinical studies suggesting a relationship between low molecular weight heparin therapy and the amount of cfDNA. What do the results of this study add? This is the first study evaluating the maternal and foetal biological factors affecting cfDNA concentrations and investigating the possible relationship between high cfDNA levels and adverse perinatal outcomes in patients with high levels of cfDNA compared to patients with normal levels of cfDNA. In the present study, it was found that an increase in foetal death could be expected in patients with higher cfDNA levels.

Background Next‐generation sequencing (NGS) and discovery of fetal cell‐free DNA (cfDNA) in the maternal circulation render possible prenatal screening for trisomy 21 (Down syndrome), trisomy 18, trisomy 13, and sex chromosome aneuploidies. The approach is called “fetal cfDNA screening” and in contrast to noninvasive conventional serum screening, it provides the identification of 98%–99% of fetuses with Down syndrome. Methods Retrospective analysis of targeted noninvasive prenatal testing (NIPT) (Clarigo Test) pregnancies with moderate risk, which we have reported between 2016 and 2018 years is presented. Two separate laboratory workflows and NGS platforms are used for the same targeted NIPT analysis. Results In total, 4,594 pregnant women were investigated. Initial 3,594 cases are studied by MiSeq platform, the last 1,000 cases by NextSeq. Failure rate for MiSeq platform is 10.9% and for NextSeq is 8.7%. Automatically reported cases constitute 75% of the MiSeq group and 87% of the NextSeq group. Conclusions Targeted NIPT results suggest that MiSeq platform could be used for NIPT which would be an essential option particularly for laboratories with low sample flow. And, the NextSeq platform has easier wet lab process and also increased success rate in automatic reporting which is suitable for centers with high number of NIPT cases.

Amaç: Preimplantasyon Genetik Tanı (PGT)’da tek gen hastalıkları taraması ile kombine HLA doku tiplemesi tayini Talasemi Majör gibi yaşamı tehdit eden ve kordon kanı ve /veya kemik iliği nakli ile tam olarak tedavi edilebilen genetik hastalıklara sahip çocuklar için etkin bir yöntemdir. Bu çalışmada, Sağlık Bilimleri Üniversitesi Dışkapı Yıldırım Beyazıt Eğitim Araştırma Hastanesi Genetik Tanı Merkezi Preimplantasyon Genetik Tanı Laboratuvarında 2014-2017 Mayıs döneminde çalışılan vakaların verileri sunulmuştur. Gereç ve Yöntem: Laboratuvarımıza Sağlık Bilimleri Üniversitesi Etlik Zübeyde Hanım Kadın Hastalıkları Tüp Bebek Merkezinden gelen 6-8 blastomer aşamasındaki 3. Gün embriyolarından alınan biyopsi örneklerinde preimplantasyon genetik tanı uygulamaları yapılan 91 vakanın genetik analiz sonuçları, mutasyon tipleri, implantasyon ve gebelik başarısı ile canlı doğum oranları değerlendirildi. Biyopsi örneklerine uygulanan lisis işleminin ardından REPLI-g Advanced DNA Single Cell Kit (Qiagen, USA) ile Whole Genom Amplification (Biorad T100, USA) gerçekleştirildikten sonra mutasyonu taşıyan DNA fragmentlerinin ve HBB geni ile ilişkili 11 markırın belirlenebilir seviyeye kadar multiplex Polimeraz Zincir Reaksiyonu (PZR) ile çoğaltılması yapıldı. Amplifikasyondan sonra DNA, normal DNA fragmentlerini mutasyonu taşıyan fragmentlerden ayırt etmeye olanak sağlayan mini-sekanslama tekniği ile kapiller elektroforez kullanılarak analiz edildi. Seçilmiş Linked Markerlar (STR: Short Tandem Repeat/ Kısa tekrar dizileri) mutasyonun tanısı için bir destek oluşturma ve bazı DNA kontaminasyonlarının belirlenmesi amacıyla kullanıldı. HLA tipleme analizlerinde uyumlu HLA genotiplerinin belirlenmesi için HLA kompleksi ile ilişkilendirilen 32 markır, multipleks PZR ile çalışılarak DNA fragmentleri kapiller elektroforez kullanılarak analiz edildi Bulgular: 86 vaka Beta Talasemi (HBB geni) , bir vaka Orak Hücreli Anemi (HBB geni), bir vaka Blackfan Diamond Anemisi (RPS19 geni), bir vaka akut lenfoblastik lösemi, bir vaka Ağır Konjental Nötropeni (HAX1 geni) ve bir vaka Fankoni Aplastik Anemisi (FANCA geni) olmak üzere toplamda 91 vaka çalışıldı. Toplam çalışılan blastomer sayısı 328, transferi yapılan vaka sayısı 41, gebelik gerçekleşen vaka sayısı 12, gerçekleşen canlı doğum sayısı 8 ve kemik iliği nakil işlemi yapılan vaka sayısı 6 olarak saptandı. Canlı doğumların tümünde gerçekleştirilen ikinci genetik analizde sağlıklı/taşıyıcı gen ve HLA tipinde hasta kardeş ile tam uyum görüldü. Sonuç: Sonuçlarımız kemik iliği nakli ile tam kür sağlanan genetik hastalıkların tedavisinde ailede sağlıklı ve HA uyumlu çocuk varlığının önemi açısından anlamlıdır. Diğer preimplantasyon genetik test uygulanan hastalıklarla karşılaştırıldığında transfer edilebilir blastomer bulma oranın düşük olduğu görülmüş ve bunun nedeninin blastomerde iki farklı genetik seçilim yapılması gerekliğinden kaynaklandığı düşünülmüştür.

EgeUn###, Exhaled breath is a source of volatile and nonvolatile biomarkers in the body that can be accessed non-invasively and used for monitoring. The collection of lung secretions by conventional methods such as bronchoalveolar lavage, induced sputum collection, and core biopsies is limited by the invasive nature of these methods. Non-invasive collection of exhaled breath condensate (EBC) provides fluid samples that are representative of airway lining fluids. Various volatile and nonvolatile biomarkers can be detected in volatile condensates, such as H2O2, nitric oxide, lipid mediators, cytokines, chemokines, DNA, and microRNAs. Studies have examined cell-freeDNA(cfDNA) in plasma samples from non-small-cell lung cancer patients, offering to new insights and fostering development of the liquid biopsy. However, few studies have examined cfDNA in EBC samples. This study examined whether EBC is an appropriate source of cfDNA using housekeeping-gene-specific primer probes and quantitative real-time polymerase chain reaction in healthy subjects. Ambient (room) air is contaminated with DNA, so caution is needed. Preliminary studies indicated that volatile biopsies are becoming an important diagnostic tool in lung cancer., Department of Scientific Research Projects of Dokuz Eylul University [KB.SAG.049]; Scientific and Technological Research Council of TurkeyTurkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [216S435, 216S591], Informed consent was obtained from all research subjects. The study was approved by the Ethics Committee of Ege University and was supported by grants from the Department of Scientific Research Projects of Dokuz Eylul University (Project no: 2017.KB.SAG.049) and the Scientific and Technological Research Council of Turkey (Project no: 216S435 and 216S591).

Periodic fever syndromes (PFSs) are a family of clinical disorders, which are characterized by recurrent episodes of fever in the absence of microbial, autoimmune or malign conditions. Most common types of PFSs are associated with four genes: MEFV, MVK, TNFRSF1A and NLRP3. This paper aims to add new data to the genotype-phenotype association of MVK-, TNFRSF-1A- and NLRP3-associated PFSs. A total number of 211 patients were evaluated. Two different approaches were used for the molecular genetic evaluation of MVK-, TNFRSF-1A- and NLRP3-associated PFSs. For the first 147 patients, Sanger sequence analysis of selected exons of MVK, TNFRSF1A and NLRP3 genes was done. For subsequent 64 patients, targeted NGS panel analysis, covering all exons of MVK, TNFRSF1A and NLRP3 genes, was used. A total number of 48 variants were detected. The "variant detection rate in index patients" was higher in the NGS group than Sanger sequencing group (19% vs. 15,1%). For the variant positive patients, a detailed genotype-phenotype table was built. In PFSs, lack of correlation exists between genotype and phenotype in the general population and even within the families. In some cases, mutations behave differently and yield unexpected phenotypes. In this study, we discussed the clinical effects of eight different variants we have detected in the MVK, TNFRSF1A and NLRP3 genes. Four of them were previously identified in patients with PFS. The remaining four were not reported in patients with PFS. Thus, we had to interpret their clinical effects by analysing their frequencies and in silico analysis predictions. We suggest that new studies are needed to evaluate the effects of these variants more clearly. To be able to demonstrate a clearer genotype-phenotype relationship, all PFS-related genes should be analysed together and the possibility of polygenic inheritance should be considered.

Chromosomal microarray (CMA) analysis for discovery of copy number variants (CNVs) is now recommended as a first-line diagnostic tool in patients with unexplained developmental delay/intellectual disability (DD/ID) and autism spectrum disorders. In this study, we present the results of CMA analysis in patients with DD/ID. Of 210 patients, pathogenic CNVs were detected in 26 (12%) and variants of uncertain clinical significance in 36 (17%) children. The diagnosis of well-recognized genetic syndromes was achieved in 12 patients. CMA analysis revealed pathogenic de novo CNVs, such as 11p13 duplication with new clinical features. Our results support the utility of CMA as a routine diagnostic test for unexplained DD/ID.

Introduction: About 80% of lung cancer cases are classified as “Non-Small Cell Lung Cancer (NSCLC)”. Case spesific, targeted therapies (precision medicine) are developed for advanced NSCLC. The main targets are the mutations of EGFR gene which are found in 10-30% of cases. Tyrosine kinase inhibitors (erlotinib, gefitinib, afatinib, osimertinib) are offered if the tumor has the mutations. At the 9-13th months of targeted tyrosine kinase therapy, drug resistance related EGFR T790M mutation may occur. Aim: Our goal is to identify the effect of liquid biopsy in the management of NSCLC and share the results of our genetic diagnosis center. Methods: We have examined 42 mutations of EGFR gene, in 114 NSCLC cases that referred to our center in 2017-2018. Plasma derived cell-free DNA (cfDNA) samples are used to identify 42 mutations of EGFR gene including exon 19 (Ex19del), exon 20 (T790M), exon 21 (L858R) variants by “Real-Time Quantitative PCR” (RT-PCR) method. Results: The EGFR mutations are found in 23 liquid biopsy cases (20%). Eleven of the cases (9.6%) have single sensitivity related mutation: Five cases have Ex19del, 4 cases have L858R, 2 cases have Ex20ins. In addition, one case has “Ex19del and G719X” together. The remaining 11 (9.6%) have the drug resistance related T790M mutation in addition to a sensitivity mutation: Six cases have “Ex19del ve T790M”, 4 cases have “L858R ve T790M”, 1 case has “L858R, S768I ve T790M”. The 11 cases with normal liquid biopsy result actually have a EGFR mutation in solid tissue biopsy. Conclusion: The liquid biopsy is successfully took its place in the identification of EGFR mutations of advanced NSCLC cases.

Background Maturity-onset diabetes of the young (MODY) is a common form of monogenic diabetes. Fourteen genes have been identified, each leading to cause a different type of MODY. The aims of this study were to reveal both known and novel variants in MODY genes in patients with MODY using targeted next generation sequencing (NGS) and to present the genotype-phenotype correlations. Methods Mutation analysis of MODY genes (GCK, HNF1A, HNF4A, HNF1B, ABCC8, INS and KCNJ11) was performed using targeted NGS in 106 patients with a clinical diagnosis of MODY. The variants were evaluated according to American College of Medical Genetics and Genomics (ACMG) Standards and Guidelines recommendations. Results A total of 18 (17%) variants were revealed among all patients. Seven variants in GCK, six in HNF4A, four in HNF1A and one in ABCC8 genes were found. Eight of them were previously published and 10 of them were assessed as novel pathogenic or likely pathogenic variants. Conclusions While the most frequent mutations are found in the HNF1A gene in the literature, most of the variants were found in the GCK gene in our patient group using the NGS method, which allows simultaneous analysis of multiple genes in a single panel.