Amy E. O’Connell, Fanny Zhou, Manasvi S

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Neonatal-Onset Chronic Diarrhea Caused by Homozygous Nonsense WNT2B Mutations Amy E. O’Connell, Fanny Zhou, Manasvi S. Shah, Quinn Murphy, Hannah Rickner, Judith Kelsen, John Boyle, Jefferson J. Doyle, Bharti Gangwani, Jay R. Thiagarajah, Daniel S. Kamin, Jeffrey D. Goldsmith, Camilla Richmond, David T. Breault, Pankaj B. Agrawal The American Journal of Human Genetics Volume 103, Issue 1, Pages 131-137 (July 2018) DOI: 10.1016/j.ajhg.2018.05.007 Copyright © 2018 American Society of Human Genetics Terms and Conditions

Figure 1 Individual Growth Charts and Sequencing (A) I-1 growth charts (upper panel, blue lines) and I-2 growth charts (lower, red lines). (B) Sequencing chromatograms for subject S1 along with maternal and paternal sequencing. (C) Pedigrees for I-1 and I-2 (left) and I-3 (right). ? = not known, sequencing not done. The American Journal of Human Genetics 2018 103, 131-137DOI: (10.1016/j.ajhg.2018.05.007) Copyright © 2018 American Society of Human Genetics Terms and Conditions

Figure 2 Gastrointestinal Histology Biopsies from endoscopy or colonoscopy were taken from I-1 and I-2. Results are H&E-stained segments from the body of the stomach, proximal duodenum, and right colon. Note loss of crypt architecture and predominance of inflammatory cells in WNT2B-deficient samples. The American Journal of Human Genetics 2018 103, 131-137DOI: (10.1016/j.ajhg.2018.05.007) Copyright © 2018 American Society of Human Genetics Terms and Conditions

Figure 3 OLFM4 Localization in WNT2B-Mutated Duodenal Crypts (A) Duodenal sections from I-1 compared with control duodenum. Control samples uniformly demonstrated OLFM4 localization at crypt bases similar to depicted section. Representative WNT2B-deficient samples were selected, with I-1 sample 1 showing no OLFM4 and I-1 sample 2 showing some OLFM4. Blue, DAPI; green, auto-fluorescence; Tx red, OLFM4. 100× mag. (B) Mean fluorescence intensity of crypt bases. Crypt base was identified using the DAPI channel, then selected base of crypt was analyzed for Texas red fluorescence. Error bars represent 25th and 75th quartiles. p value for unpaired t test with Walsh adjustment. The American Journal of Human Genetics 2018 103, 131-137DOI: (10.1016/j.ajhg.2018.05.007) Copyright © 2018 American Society of Human Genetics Terms and Conditions

Figure 4 Intestinal Enteroids Derived from Biopsy Samples and Grown in Matrigel with Standard Enteroid Media (A–C) Representative images of enteroids from (A) a healthy control individual and from (B) WNT2B-deficient individual (I-2) after 2–3 days and (C) after 4–5 days, when enteroids have collapsed. (D–F) Representative enteroids from WNT2B-deficient individual (I-1) (D) treated with standard media, (E) treated with CHIR-99021, or (F) treated with recombinant murine WNT2B (rmWNT2B). Scale bars are shown at 200 μm. The American Journal of Human Genetics 2018 103, 131-137DOI: (10.1016/j.ajhg.2018.05.007) Copyright © 2018 American Society of Human Genetics Terms and Conditions

Figure 5 Comparison of Enteroid Cultures in Standard Enteroid Media (A) Stitched low-magnification comparison of enteroid cultures from healthy control individual (left) versus WNT2B-deficient individual (I-1) treated with recombinant murine WNT2B (rmWNT2B, right) at passage 4. Scale bars are shown at 2 mm. (B) Enteroid size comparison between healthy control samples and WNT2B-deficient enteroids treated with WNT2B. Boxplot is max and min numbers with 75th and 25th quartiles. p value for unpaired t test with Walsh adjustment. (C) Semiquantitative analysis showing exponential expansion of enteroid numbers from the control individual scored for the number of wells at each passage compared with enteroids from the WNT2B-deficient individual, which survived each passage but failed to expand in number. The American Journal of Human Genetics 2018 103, 131-137DOI: (10.1016/j.ajhg.2018.05.007) Copyright © 2018 American Society of Human Genetics Terms and Conditions

Figure 6 WNT2B Mutant Enteroids Demonstrate Altered Expression of βCATENIN-Target and Inflammatory Genes Duodenal enteroid cultures from I-1 were cultured with recombinant murine WNT2B and gene expression assessed by qRT-PCR. Relative expression is displayed as compared with control enteroids. Expression was normalized to GAPDH. The American Journal of Human Genetics 2018 103, 131-137DOI: (10.1016/j.ajhg.2018.05.007) Copyright © 2018 American Society of Human Genetics Terms and Conditions