Unraveling the Genetics of Congenital Diaphragmatic Hernia: An Ongoing Challenge

Frontiers in Pediatrics

Wilfred F. J. van Ijcken²  Robbert J. Rottier²  Rutger W. W. Brouwer²  Hennie T. Bruggenwirth³  Annelies de Klein³  Marieke F. van Dooren³  Erwin Brosens³  Frank Sleutels³  Dick Tibboel⁴  J. Marco Schnater⁴  Rene M. H. Wijnen⁴  Suzan C. M. Cochius-Den Otter⁴  Kim S. van Weelden⁴  Danielle C. M. Veenma⁵  Nina C. J. Peters⁶  Alex J. Eggink⁶  Heiko Martin Reutter⁸  Charlotte Bendixen⁹ 

[1] Center for Biomics, Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands;Department of Cell Biology, Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands;Department of Clinical Genetics, Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands;Department of Pediatric Surgery and Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands;Department of Pediatrics, Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands;Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynecology, Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands;Institute of Human Genetics, University Hospital of Bonn, Bonn, Germany;Neonatology and Pediatric Intensive Care, Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany;Unit of Pediatric Surgery, Department of General, Visceral, Vascular and Thoracic Surgery, University Hospital Bonn, Bonn, Germany;

关键词: foregut;    genetics;    development;    counseling;    diaphragm;    hernia;   

DOI  :  10.3389/fped.2021.800915

来源: DOAJ

【 摘 要 】

Congenital diaphragmatic hernia (CDH) is a congenital structural anomaly in which the diaphragm has not developed properly. It may occur either as an isolated anomaly or with additional anomalies. It is thought to be a multifactorial disease in which genetic factors could either substantially contribute to or directly result in the developmental defect. Patients with aneuploidies, pathogenic variants or de novo Copy Number Variations (CNVs) impacting specific genes and loci develop CDH typically in the form of a monogenetic syndrome. These patients often have other associated anatomical malformations. In patients without a known monogenetic syndrome, an increased genetic burden of de novo coding variants contributes to disease development. In early years, genetic evaluation was based on karyotyping and SNP-array. Today, genomes are commonly analyzed with next generation sequencing (NGS) based approaches. While more potential pathogenic variants are being detected, analysis of the data presents a bottleneck—largely due to the lack of full appreciation of the functional consequence and/or relevance of the detected variant. The exact heritability of CDH is still unknown. Damaging de novo alterations are associated with the more severe and complex phenotypes and worse clinical outcome. Phenotypic, genetic—and likely mechanistic—variability hampers individualpatient diagnosis, short and long-term morbidity prediction and subsequent care strategies. Detailed phenotyping, clinical follow-up at regular intervals and detailed registries are needed to find associations between long-term morbidity, genetic alterations, and clinical parameters. Since CDH is a relatively rare disorder with only a few recurrent changes large cohorts of patients are needed to identify genetic associations. Retrospective whole genome sequencing of historical patient cohorts using will yield valuable data from which today's patients and parents will profit Trio whole genome sequencing has an excellent potential for future re-analysis and data-sharing increasing the chance to provide a genetic diagnosis and predict clinical prognosis. In this review, we explore the pitfalls and challenges in the analysis and interpretation of genetic information, present what is currently known and what still needs further study, and propose strategies to reap the benefits of genetic screening.

【 授权许可】

Unknown