Intellectual disability (ID) is a clinically and genetically heterogeneous
disorder, affecting 1–3% of the general population. Although
research into the genetic causes of ID has recently gained momentum,
identification of pathogenic mutations that cause autosomal recessive ID (ARID)
has lagged behind, predominantly due to non-availability of sizeable families.
Here we present the results of exome sequencing in 121 large consanguineous
Pakistani ID families. In 60 families, we identified homozygous or compound
heterozygous DNA variants in a single gene, 30 affecting reported ID genes and
30 affecting novel candidate ID genes. Potential pathogenicity of these alleles
was supported by co-segregation with the phenotype, low frequency in control
populations and the application of stringent bioinformatics analyses. In another
eight families segregation of multiple pathogenic variants was observed,
affecting 19 genes that were either known or are novel candidates for ID.
Transcriptome profiles of normal human brain tissues showed that the novel
candidate ID genes formed a network significantly enriched for transcriptional
co-expression (P<0.0001) in the frontal cortex during fetal
development and in the temporal–parietal and sub-cortex during infancy
through adulthood. In addition, proteins encoded by 12 novel ID genes directly
interact with previously reported ID proteins in six known pathways essential
for cognitive function (P<0.0001). These results suggest that
disruptions of temporal parietal and sub-cortical neurogenesis during infancy
are critical to the pathophysiology of ID. These findings further expand the
existing repertoire of genes involved in ARID, and provide new insights into the
molecular mechanisms and the transcriptome map of ID.