Here we report on a singleton patient affected by a complicated congenital syndrome characterized by growth delay, retinal dystrophy, sensorineural deafness, myopathy, ataxia, combined pituitary hormone deficiency, associated with mitochondrial impairment. Targeted clinical exome sequencing led to the identification of a homozygous missense variant in OTX2. Since only dominant mutations within OTX2 have been associated with cases of syndromic microphthalmia, retinal dystrophy with or without pituitary dysfunctions, this represents the first report of an OTX2 recessive mutation. Part of the phenotype, including ataxia, myopathy and multiple mitochondrial respiratory chain defects, seemed not related to OTX2. Further analysis of next generation sequencing (NGS) data revealed additional candidate variants: a homozygous variant in LETM1, and heterozygous rare variants in AFG3L2 and POLG. All three genes encode mitochondrial proteins and the last two are known to be associated with ataxia, a neurological sign present also in the father of the proband. With our study, we aim to encourage the integration of NGS data with a detailed analysis of clinical description and family history in order to unravel composite genotypes sometimes associated with complicated phenotypes. K E Y W O R D S AFG3L2, complex congenital syndrome, LETM1, OTX2, POLG 1 | INTRODUCTION In the last decade, the development of new next generation sequencing (NGS) technologies such as whole genome/exome sequencing, has rapidly offered a growing opportunity to provide large-scale and high sensitivity genomic screening allowing the identification of new pathogenic variants associated with rare inherited diseases and overcoming most of the limitations of a candidate-gene based approach to diagnostics. Even though, complex congenital phenotypes in singleton cases, thus without a clear Mendelian inheritance pattern, still represent one of the main pitfalls of these techniques. A close interaction between clinicians and geneticists is fundamental in order to allow a proper evaluation of the NGS data, especially considering the growing number of reports about cases with intricate clinical presentation and composite genetic basis.In this report, we describe a singleton patient affected by a complicated congenital syndrome characterized by growth delay, retinal dystrophy, sensorineural deafness, myopathy, ataxia, combined pituitary hormone deficiency (CPHD), associated with mitochondrial impairment. Genetic and clinical data were deeply investigated in order to find genotype-phenotype correlations.
| MATERIALS AND METHODSClinical, genetic, and histo/biochemical evaluations were performed upon acquisition of informed consent from all the subjects involved in this study, as required by the Ethical Committee of the Fondazione † Alessia Catania and Andrea Legati contributed equally to this study.