We report the identification of a recurrent 520-kbp 16p12.1 microdeletion significantly associated with childhood developmental delay. The microdeletion was detected in 20/11,873 cases vs. 2/8,540 controls (p=0.0009, OR=7.2) and replicated in a second series of 22/9,254 cases vs. 6/6,299 controls (p=0.028, OR=2.5). Most deletions were inherited with carrier parents likely to manifest neuropsychiatric phenotypes (p=0.037, OR=6). Probands were more likely to carry an additional large CNV when compared to matched controls (10/42 cases, p=5.7×10-5, OR=6.65). Clinical features of cases with two mutations were distinct from and/or more severe than clinical features of patients carrying only the co-occurring mutation. Our data suggest a two-hit model in which the 16p12.1 microdeletion both predisposes to neuropsychiatric phenotypes as a single event and exacerbates neurodevelopmental phenotypes in association with other large deletions or duplications. Analysis of other microdeletions with variable expressivity suggests that this two-hit model may be more generally applicable to neuropsychiatric disease.

Epithelial Na ؉ channels (ENaCs) are activated by extracellular trypsin or by co-expression with channelactivating proteases, although there is no direct evidence that these proteases activate ENaC by cleaving the channel. We previously demonstrated that the ␣ and ␥ subunits of ENaC are cleaved during maturation near consensus sites for furin cleavage. Using site-specific mutagenesis of channel subunits, ENaC expression in furin-deficient cells, and furin-specific inhibitors, we now report that ENaC cleavage correlates with channel activity. Channel activity in furin-deficient cells was rescued by expression of furin. Our data provide the first example of a vertebrate ion channel that is a substrate for furin and whose activity is dependent on its proteolysis.Epithelial Na ϩ channels are expressed in apical membranes of high resistance Na ϩ -transporting epithelia. These channels have a key role in the regulation of extracellular fluid volume, blood pressure, and airway fluid volume. ENaCs 1 are composed of three structurally related subunits, termed ␣, ␤, and ␥, with a presumed ␣ 2 ␤ 1 ␥ 1 subunit stoichiometry (1, 2), although an alternative stoichiometry has been proposed (3). Each subunit has two membrane-spanning domains that are connected by a large extracellular loop and intracellular NH 2 and COOH termini. Residues preceding and within the second membranespanning domain form the channel pore (4 -6).Previous studies have demonstrated that ENaC activity is regulated by proteases. Extracellular trypsin has been shown to increase channel activity, while extracellular serine protease inhibitors, such as aprotinin and bikunin, have been shown to decrease channel activity (7)(8)(9)(10)(11)(12). Channel activation by proteases likely reflects changes in channel gating (8,12). ENaCs characteristically have long open and closed times, generally on the order of seconds (13,14). However, a population of channels has been described that exhibit only brief (50 ms) openings and have long closed states (13,14). Caldwell et al. (12) recently reported that extracellular trypsin converts these near-silent Na ϩ channels to channels that exhibit the typically long open and closed times. A family of channel-activating serine proteases, referred to as CAPs, have been identified based on their ability to activate ENaC when co-expressed in heterologous systems (7,15,16). These serine proteases include CAP1 (or prostasin), CAP2, CAP3, and a member of a family of transmembrane serine proteases (TMPRSS3) (7,15,16). However, it is not known whether proteolysis of ENaC subunits or cleavage of a distinct regulatory protein is responsible for the activation of Na ϩ channels.We recently reported that maturation of mouse ENaC in both Chinese hamster ovary (CHO) and Madin-Darby canine kidney (MDCK) cells involves proteolytic cleavage of the ␣ and ␥ subunits (17). Expression of individual subunits revealed full-length forms of the ␣, ␤, and ␥ subunits (95, 96, and 93 kDa, respectively) that had immature N-glycans. However, co-expression o...

Despite their clinical significance, characterization of balanced chromosomal abnormalities (BCAs) has largely been restricted to cytogenetic resolution. We explored the landscape of BCAs at nucleotide resolution in 273 subjects with a spectrum of congenital anomalies. Whole-genome sequencing revised 93% of karyotypes and revealed complexity that was cryptic to karyotyping in 21% of BCAs, highlighting the limitations of conventional cytogenetic approaches. At least 33.9% of BCAs resulted in gene disruption that likely contributed to the developmental phenotype, 5.2% were associated with pathogenic genomic imbalances, and 7.3% disrupted topologically associated domains (TADs) encompassing known syndromic loci. Remarkably, BCA breakpoints in eight subjects altered a single TAD encompassing MEF2C, a known driver of 5q14.3 microdeletion syndrome, resulting in decreased MEF2C expression. This study proposes that sequence-level resolution dramatically improves prediction of clinical outcomes for balanced rearrangements, and provides insight into novel pathogenic mechanisms such as altered regulation due to changes in chromosome topology.

, Melissa Yssel, MB ChB, FC Path(SA) Chem 139, and Wendy M. Zakowicz, BS 79 Purpose: To achieve clinical validation of cutoff values for newborn screening by tandem mass spectrometry through a worldwide collaborative effort. Methods: Cumulative percentiles of amino acids and acylcarnitines in dried blood spots of approximately 25-30 million normal newborns and 10,742 deidentified true positive cases are compared to assign clinical significance, which is achieved when the median of a disorder range is, and usually markedly outside, either the 99th or the 1st percentile of the normal population. The cutoff target ranges of analytes and ratios are then defined as the interval between selected percentiles of the two populations. When overlaps occur, adjustments are made to maximize sensitivity and specificity taking all available factors into consideration.

ARF is common in ICU patients and has a persistent negative impact on outcomes, although the majority of ARF is not severe enough to require dialysis support. The mortality of patients with ARF from all causes is almost exactly similar to that noted using the same criteria two decades ago. More profound ARF requiring dialysis continues to have an even greater mortality. Nevertheless, acute declines in renal function are associated with a mortality that is not well explained simply by loss of organ function. The majority of ARF patients who did not require dialysis still had a considerably higher mortality than the ESRD patients, all of whom required dialysis; while ARF patients who did require dialysis had a much higher morality than ESRD patients. APACHE III performs well and captures the mortality of patients with ARF at the time of scoring. Development of ARF after scoring has a profound effect on standardized mortality. We were unable to identify a unique mortality associated with ARF, but the presence of measurable renal insufficiency continues to be a sensitive marker for poor outcome.