Allelic Mutations of KITLG, Encoding KIT Ligand, Cause Asymmetric and Unilateral Hearing Loss and Waardenburg Syndrome Type 2  Celia Zazo Seco, Luciana.

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Allelic Mutations of KITLG, Encoding KIT Ligand, Cause Asymmetric and Unilateral Hearing Loss and Waardenburg Syndrome Type 2  Celia Zazo Seco, Luciana Serrão de Castro, Josephine W. van Nierop, Matías Morín, Shalini Jhangiani, Eva J.J. Verver, Margit Schraders, Nadine Maiwald, Mieke Wesdorp, Hanka Venselaar, Liesbeth Spruijt, Jaap Oostrik, Jeroen Schoots, Jeroen van Reeuwijk, Stefan H. Lelieveld, Patrick L.M. Huygen, María Insenser, Ronald J.C. Admiraal, Ronald J.E. Pennings, Lies H. Hoefsloot, Alejandro Arias-Vásquez, Joep de Ligt, Helger G. Yntema, Joop H. Jansen, Donna M. Muzny, Gerwin Huls, Michelle M. van Rossum, James R. Lupski, Miguel Angel Moreno-Pelayo, Henricus P.M. Kunst, Hannie Kremer  The American Journal of Human Genetics  Volume 97, Issue 5, Pages 647-660 (November 2015) DOI: 10.1016/j.ajhg.2015.09.011 Copyright © 2015 The American Society of Human Genetics Terms and Conditions

Figure 1 Families Affected by KITLG Mutations (A) Pedigree of family W09-1628, affected by NS-UHL/AHL. Asterisks indicate individuals who were genotyped with HumanOmniExpress BeadChip arrays. For privacy reasons, the genotype for the c.286_303delinsT variant has not been indicated for unaffected individuals, except for those with affected offspring. Abbreviations are as follows: M, mutant allele c.286_303delinsT; +, the wild-type allele; ?, unclear affection status. (B) Pedigree of family S1489, affected by NS-AHL. Abbreviations are as follows: M, the c.200_202del variant; +, the wild-type allele. (C) Pedigree of family 12-01744, affected by WS2. Abbreviations are as follows: M, the variant c.310C>G; +, the wild-type allele; ?, unclear affection status. The American Journal of Human Genetics 2015 97, 647-660DOI: (10.1016/j.ajhg.2015.09.011) Copyright © 2015 The American Society of Human Genetics Terms and Conditions

Figure 2 Pure Tone Audiometry in Families Affected by KITLG Mutations (A) Pure tone audiograms for family-W09-1628 individuals with UHL (III:5) and AHL (V:6). (B) Pure tone audiograms for family S1489, affected by AHL. (C) Pure tone audiograms for family 12-01744, affected by WS2. Abbreviations are as follows: R, right ear; L, left ear; P95, thresholds according to the P95 of presbyacusis (ISO 7029:1984).14 The American Journal of Human Genetics 2015 97, 647-660DOI: (10.1016/j.ajhg.2015.09.011) Copyright © 2015 The American Society of Human Genetics Terms and Conditions

Figure 3 Eye and Skin Hypopigmentation Phenotypes in Family 12-01744, Affected by WS2 (A) Heterochromia iridis in the index case, individual II:1. (B) Signs of heterochromia iridis in his mother (I:2). (C) A hypopigmented, sharply demarcated macule on the thorax of individual II:1 and (D) on the upper arm. A nummular, sharply demarcated hyperpigmented macula at the back, detected by a Wood’s lamp. The American Journal of Human Genetics 2015 97, 647-660DOI: (10.1016/j.ajhg.2015.09.011) Copyright © 2015 The American Society of Human Genetics Terms and Conditions

Figure 4 Genetic Defects Underlying UHL and AHL and Schematic Representation of the Genomic Structure of KITLG and of the Encoded KITLG Isoforms (A) Electropherograms of pCR4-topo clones representing the wild-type and c.286_303delinsT alleles of KITLG exon 4 of individual IV:1 (family W09-1628). (B) Electropherograms of pCR4-topo clones representing the wild-type and c.200_202del alleles of KITLG exon 4 of individual III:1 (family S1489). (C) Partial nucleotide sequences of KITLG exon 4 of case II:1 of family 12-01744. The mutated nucleotide is marked by an arrowhead. GenBank: NM_003994.5 and NM_000899.4 were used as reference sequences. (D) Exon 6 is alternatively spliced. The yellow dots represent the gain-of-function mutations c.98C>T, c.100A>C, and c.107A>G, causative of familial hyper- and hypopigmentation syndromes. The green and red dots represent the mutations identified to be causative of NS-UHL/AHL in the present study. The white dot represents the mutation identified in a family with WS2. All depicted variants affect the KIT ligand domain of both the soluble and transmembrane isoforms of KITLG. Abbreviation is as follows: WT, wild-type. The American Journal of Human Genetics 2015 97, 647-660DOI: (10.1016/j.ajhg.2015.09.011) Copyright © 2015 The American Society of Human Genetics Terms and Conditions

Figure 5 Effect of KITLG Mutations on Subcellular Localization and Excretion of the Transmembrane and Soluble KITLG Isoforms, Respectively (A) WGA staining of NIH 3T3 cells transfected with constructs encoding the FLAG-tagged wild-type, p.His67_Cys68delinsArg, and p.Leu104Val transmembrane isoform of KITLG. Cells were incubated with anti-FLAG antibodies and Alexa-488-conjugated goat anti-mouse (left column), and WGA Texas Red-X is visualized in the middle column. In the right column, the signals of the left and middle columns are merged. Co-localization of WGA with wild-type and p.Leu104Val KITLG was observed at the cell membrane but not with p.His67_Cys68delinsArg KITLG. WGA (red) and KITLG (green) fluorescence intensity profiles were plotted as a function of distance with ImageJ software. Scale bar represents 25 μm. (B) The amount of soluble p.Leu104Val KITLG is significantly reduced (p < 10−3, Student’s t test) in the medium of transfected NIH 3T3 cells as measured by ELISA. No soluble KITLG was detected for the p.His67_CysdelinsArg and p.Ser96Ter mutations. Data are means ± SD of four independent experiments. Abbreviation is as follows: WT, wild-type. The American Journal of Human Genetics 2015 97, 647-660DOI: (10.1016/j.ajhg.2015.09.011) Copyright © 2015 The American Society of Human Genetics Terms and Conditions