Review of the phenotypic spectrum associated with haploinsufficiency of MYRF

• Published in: American journal of medical genetics. Part A Vol. 179; no. 7; pp. 1376 - 1382
• Main Authors: Rossetti, Linda Z., Glinton, Kevin, Yuan, Bo, Liu, Pengfei, Pillai, Nishitha, Mizerik, Elizabeth, Magoulas, Pilar, Rosenfeld, Jill A., Karaviti, Lefkothea, Sutton, Vernon R., Lalani, Seema R., Scott, Daryl A.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.07.2019; Wiley Subscription Services, Inc
• Subjects: congenital diaphragmatic hernia; congenital heart defects; Cryptorchidism; Defects; Diaphragm; Genitalia; Genitourinary tract; Haploinsufficiency; Heart; Hernia; Hernias; Hypoplasia; Lungs; Myelin; myelin regulatory factor; MYRF; Neonates; Phenotypes; Point mutation; Pulmonary arteries; Pulmonary artery; pulmonary hypoplasia; Splicing; urogenital anomalies; congenital diaphragmatic hernia; MYRF; pulmonary hypoplasia; urogenital anomalies; myelin regulatory factor; congenital heart defects
• ISSN: 1552-4825; 1552-4833; 1552-4833
• DOI: 10.1002/ajmg.a.61182

The myelin regulatory factor gene (MYRF) encodes a transcription factor that is widely expressed. There is increasing evidence that heterozygous loss‐of‐function variants in MYRF can lead to abnormal development of the heart, genitourinary tract, diaphragm, and lungs. Here, we searched a clinical database containing the results of 12,000 exome sequencing studies. We identified three previously unreported males with putatively deleterious variants in MYRF: one with a point mutation predicted to affect splicing and two with frameshift variants. In all cases where parental DNA was available, these variants were found to have arisen de novo. The phenotypes identified in these subjects included a variety of congenital heart defects (CHD) (hypoplastic left heart syndrome, scimitar syndrome, septal defects, and valvular anomalies), genitourinary anomalies (ambiguous genitalia, hypospadias, and cryptorchidism), congenital diaphragmatic hernia, and pulmonary hypoplasia. The phenotypes seen in our subjects overlap those described in individuals diagnosed with PAGOD syndrome [MIM# 202660], a clinically defined syndrome characterized by pulmonary artery and lung hypoplasia, agonadism, omphalocele, and diaphragmatic defects that can also be associated with hypoplastic left heart and scimitar syndrome. These cases provide additional evidence that haploinsufficiency of MYRF causes a genetic syndrome whose cardinal features include CHD, urogenital anomalies, congenital diaphragmatic hernia, and pulmonary hypoplasia. We also conclude that consideration should be given to screening individuals with PAGOD for pathogenic variants in MYRF, and that individuals with MYRF deficiency who survive the neonatal period should be monitored closely for developmental delay and intellectual disability.