DVL1 Frameshift Mutations Clustering in the Penultimate Exon Cause Autosomal- Dominant Robinow Syndrome  Janson White, Juliana F. Mazzeu, Alexander Hoischen,

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DVL1 Frameshift Mutations Clustering in the Penultimate Exon Cause Autosomal- Dominant Robinow Syndrome  Janson White, Juliana F. Mazzeu, Alexander Hoischen, Shalini N. Jhangiani, Tomasz Gambin, Michele Calijorne Alcino, Samantha Penney, Jorge M. Saraiva, Hanne Hove, Flemming Skovby, Hülya Kayserili, Elicia Estrella, Anneke T. Vulto-van Silfhout, Marloes Steehouwer, Donna M. Muzny, V. Reid Sutton, Richard A. Gibbs, James R. Lupski, Han G. Brunner, Bregje W.M. van Bon, Claudia M.B. Carvalho  The American Journal of Human Genetics  Volume 96, Issue 4, Pages 612-622 (April 2015) DOI: 10.1016/j.ajhg.2015.02.015 Copyright © 2015 The American Society of Human Genetics Terms and Conditions

Figure 1 Clinical Presentation of the Individuals with DRS in This Study Subjects (clockwise from the top left) BAB5264, 016462, 016516, 016517, and 017604 have DRS due to mutations in DLV1 and show characteristic facial features of frontal bossing with a high, broad forehead, hypertelorism, a broad nasal tip, and low-set ears. The American Journal of Human Genetics 2015 96, 612-622DOI: (10.1016/j.ajhg.2015.02.015) Copyright © 2015 The American Society of Human Genetics Terms and Conditions

Figure 2 DVL1 Variants Identified in This Study (A) Position of known functional domains and their distribution within the DVL1 transcript. The N-terminal DIX domain is most likely involved in regulating canonical Wnt signaling, leading to β-catenin stability;22 the PDZ domain is required for DVL1-mediated microtubule stabilization23 and for regulation of signal transduction. The C-terminal DEP domain is predicted to be important for protein interaction and most likely has a role in signal transduction; it can be found in other proteins involved in G protein signaling.24 The approximate locations of variants identified for each affected individual all cluster within exon 14 and display the same PTC within exon 15. (B) Sanger sequencing of allele-specific PCR-product clones confirmed the presence of frameshift mutations in each affected individual and revealed a C insertion in subject BAB4073. Electropherograms displaying the cloning results of both alleles for six affected individuals are shown. Electropherograms for individual 016462, who carries the recurrent deletion c.1505_1517, are displayed in Figure S3. Underlined bases are deleted in the mutant allele, and the highlighted pink base (for subject BAB4073) in the mutant allele represents an insertion that did not exist in the reference allele. (C) Predicted amino acid sequence with a change in the reading frame for part of exon 14 and exon 15. All variants in affected individuals have an identical PTC within exon 15. Identical amino acids are highlighted in yellow. Asterisks indicate termination codons. The American Journal of Human Genetics 2015 96, 612-622DOI: (10.1016/j.ajhg.2015.02.015) Copyright © 2015 The American Society of Human Genetics Terms and Conditions

Figure 3 mRNA Expression of Mutant Alleles (A) Schematic representation of the DVL1 coding region. Green ovals display approximate locations of TaqMan probes Hs00182896_m1 and Hs00737028_m1. Arrows show approximate locations of primers 5′-TGCTACTACGTCTTCGGGGA-3′ (exon 13 fwd) and 5′-TGTGATCCGATTCACTGCCA-3′ (exon 15 rev), which were used to amplify cDNA of mRNA extracted from subjects’ and parents’ leukocytes. (B) Pedigrees of subjects BAB4073 and BAB5264 and available parents for RNA isolation. Agarose gel shows a 343-bp RT-PCR band, which was amplified with primers 5′-TGCTACTACGTCTTCGGGGA-3′ (exon 13 fwd) and 5′-TGTGATCCGATTCACTGCCA-3′ (exon 15 rev); below, electropherograms display sequencing results of amplified cDNA. Affected individuals harbor frameshift mutations identical to the genomic mutations identified. The variants are present in the cDNA of affected individuals but are not present in unaffected parents. (C) Levels of DVL1 expression in leukocytes were measured by qPCR with TaqMan probes Hs00182896_m1 and Hs00737028_m1. For evaluating relative expression of DVL1, the ΔΔCT method was used with TBP as the endogenous control and one unaffected parent per family as the relative control. This experiment was replicated once and showed similar results. The American Journal of Human Genetics 2015 96, 612-622DOI: (10.1016/j.ajhg.2015.02.015) Copyright © 2015 The American Society of Human Genetics Terms and Conditions