Oral-facial-digital type I syndrome (OFDI) is characterised by an X-linked dominant mode of inheritance with lethality in males. Clinical features include facial dysmorphism with oral, dental and distal abnormalities, polycystic kidney disease and central nervous system malformations. Considerable allelic heterogeneity has been reported within the OFD1 gene, but DNA bi-directional sequencing of the exons and intron-exon boundaries of the OFD1 gene remains negative in more than 20 % of cases. We hypothesized that genomic rearrangements could account for the majority of the remaining undiagnosed cases. Thus, we took advantage of two independent available series of patients with OFDI syndrome and negative DNA bi-directional sequencing of the exons and intron-exon boundaries of the OFD1 gene from two different European labs: 13/36 cases from the French lab; 13/95 from the Italian lab. All patients were screened by a semiquantitative fluorescent multiplex method (QFMPSF) and relative quantification by real-time PCR (qPCR). Six OFD1 genomic deletions (exon 5, exons 1-8, exons 1-14, exons 10-11, exons 13-23 and exon 17) were identified, accounting for 5 % of OFDI patients and for 23 % of patients with negative mutation screening by DNA sequencing.
INTRODUCTIONOral-facial-digital syndrome type I (OFDI; MIM# 311200) or Papillon-Léage-Psaume syndrome, which belongs to the heterogeneous group of oral-facial-digital syndromes (OFDS), is characterised by an X-linked dominant mode of inheritance and is lethal in males (Gorlin et al., 2001). Clinical features include facial dysmorphism with hypoplasia of alae nasi, oral frenula and clefts, lingual hamartoma, digital asymmetry with brachydactyly of hands, various degrees of mental deficiency, frequent brain malformations (absence of corpus callosum, porencephaly, hydrocephalus, vermis hypoplasia and Dandy-Walker malformation), and adult polycystic kidney disease (Scolari et al., 1997;Odent et al., 1998; Thauvin-Robinet et al., 2006, Prattichizzo et al., in press). Clinical variability is high and diagnosis may be difficult in minor cases. Moreover, the phenotype overlaps with those reported in the other forms of OFD syndromes (Gurrieri et al., 2007). The OFDI syndrome results from mutations in the OFD1 gene (MIM# 300170) (Xp22.2-22.3) with 23 coding exons (Ferrante et al., 2001). OFD1 is also implicated in a novel X-linked recessive mental retardation syndrome comprising macrocephaly and ciliary dysfunction (Budny et al., 2006). In OFDI syndrome, 92 mutations (frameshift, nonsense, missense and splice mutations) have been identified by DNA bi-directional sequencing of the exons and intron-exon boundaries of the OFD1 gene (Ferrante et al., 2001;Rakkolainen et al., 2002;Romio et al., 2003;Thauvin-Robinet et al., 2006; Prattichizzo et al., in press).To date, no mutation of the OFD1 gene has been detected in about 20% of patients presenting with clinical signs +/-a familial history consistent with OFD1 syndrome (Ferrante et al., 2001;Thauvin-Robinet et al., 2006; Prattichizzo et...