Intellectual disability (ID) is frequent in the general population, with 1 in 50 individuals directly affected worldwide. The multiple etiologies include X-linked ID (XLID). Among syndromic XLID, few syndromes present severe ID associated with postnatal microcephaly and midline stereotypic hand movements. We report on three male patients with ID, midline stereotypic hand movements, hypotonia, hyperkinesia, strabismus, as well as seizures (2/3), and non-inherited and postnatal onset microcephaly (2/3). Using array CGH and exome sequencing we characterised two truncating mutations in IQSEC2, namely two de novo intragenic duplication mapped to the Xp11.22 region and a nonsense mutation in exon 7. We propose that truncating mutations in IQSEC2 are responsible for syndromic severe ID in male patients and should be screened in patients without mutations in MECP2, FOXG1, CDKL5 and MEF2C. Keywords: syndromic X-linked intellectual disability; microcephaly; IQSEC2-truncating mutations
INTRODUCTIONIntellectual disability (ID) is defined by substantial limitations in cognitive functioning (intellectual quotient o70) coupled with a deficit in adaptive behaviour and onset before the age of 18 years. ID is frequent in the general population, with as many as 1 in every 50 individuals directly affected worldwide. 1,2 Among the genetic etiologies of ID, XLID is a frequent cause, estimated at 5-10% of all cases in males, with a major genetic heterogeneity. Indeed, more than 102 genes have been involved in syndromic form of XLID, making molecular diagnosis and thus genetic counselling difficult. 2-4 Among XLID, syndromic and nonsyndromic forms are delineated based on observed additional features that are associated with ID such as seizures, abnormal growth parameters, visceral or cerebral malformation, and so on. Recently, mutations in IQSEC2 (Sec7 domain of, and IQ-like domain) have been shown to cause nonsyndromic XLID with behavioural disturbance. 5-8 We report on three male patients with severe syndromic XLID and truncating mutations in IQSEC2.
PATIENTS AND METHODS
Patient 1This patient was referred to the Genetics Department for severe ID and postnatal microcephaly. He is the only child born to healthy unrelated parents native to the south of France. Pregnancy was uneventful. The boy was born at 37 ½ weeks of gestation full term by caesarean section due to an abnormal presentation. Birth measurements were in the normal range (occipital frontal circumference (OFC) 36 cm, þ 1 SD; birth weight 3430 g, mean; birth length 52.5 cm, þ 1 SD). Postnatal course was marked by psychomotor retardation with neonatal hypotonia, hyperkinesia, strabismus and non-inherited progressive postnatal microcephaly with OFC at À2 SD at 6 months of age. He sat at 12 months and did not vocalize at 15 months. At the time of the last evaluation, he was 4 years old. He presented with normal facial features ( Figure 1a). OFC was at 48 cm, À2.5 SD; weight at 2 kg, þ 2 SD and length at 106 cm, þ 1 SD. Language was not acquired and he could not walk alone. He h...