Exome Analysis of a Family With Pleiotropic Congenital Heart Disease

• Published in: Circulation. Cardiovascular genetics Vol. 5; no. 2; pp. 175 - 182
• Main Authors: Arrington, Cammon B, Bleyl, Steven B, Matsunami, Norisada, Bonnell, Gabriel D, Otterud, Brith E.M, Nielsen, Douglas C, Stevens, Jeffrey, Levy, Shawn, Leppert, Mark F, Bowles, Neil E
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD American Heart Association, Inc 01.04.2012; Lippincott Williams & Wilkins
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Cardiology. Vascular system; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Exome; Female; Genetic Predisposition to Disease; Heart; Heart Defects, Congenital - genetics; Humans; Male; Medical sciences; Middle Aged; Pedigree; Polymorphism, Single Nucleotide; Sequence Analysis, DNA; Young Adult; myosin heavy chain; Heavy peptide chain; atrial septal defects; Nucleotide sequence; Family study; Cardiovascular disease; Intracardiac defect; Congenital disease; exome sequencing; mutations; Malformation; Myosin; Atrial septal defect; Mutation; Congenital cardiopathy; Sequencing
• DOI: 10.1161/CIRCGENETICS.111.961797
• ISSN: 1942-325X

BACKGROUND—A number of single gene defects have been identified in patients with isolated or nonsyndromic congenital heart defects (CHDs). However, due to significant genetic heterogeneity, candidate gene approaches have had limited success in finding high-risk alleles in most cases. The purpose of this study was to use exome sequencing to identify high-risk gene variants in a family with highly penetrant pleiotropic CHD. METHODS AND RESULTS—DNA samples from 2 members of a family with diverse CHD were analyzed by exome sequencing. Variants were filtered to eliminate common variants and sequencing artifacts and then prioritized based on the predicted effect of the variant and on gene function. The remainder of the family was screened using polymerase chain reaction, high-resolution melting analysis, and DNA sequencing to evaluate variant segregation. After filtering, >2000 rare variants (including single nucleotide substitutions and indels) were shared by the 2 individuals. Of these, 46 were nonsynonymous, 3 were predicted to alter splicing, and 6 resulted in a frameshift. Prioritization reduced the number of variants potentially involved in CHD to 18. None of the variants completely segregated with CHD in the kindred. However, 1 variant, Myh6 Ala290Pro, was identified in all but 1 affected individual. This variant was previously identified in a patient with tricuspid atresia and large secundum atrial septal defect. CONCLUSIONS—It is likely that next-generation sequencing will become the method of choice for unraveling the complex genetics of CHD, but information gained by analysis of transmission through families will be crucial.