Mutations in NOTCH1 Cause Adams-Oliver Syndrome

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Mutations in NOTCH1 Cause Adams-Oliver Syndrome Anna-Barbara Stittrich, Anna Lehman, Dale L. Bodian, Justin Ashworth, Zheyuan Zong, Hong Li, Patricia Lam, Alina Khromykh, Ramaswamy K. Iyer, Joseph G. Vockley, Rajiv Baveja, Ermelinda Santos Silva, Joanne Dixon, Eyby L. Leon, Benjamin D. Solomon, Gustavo Glusman, John E. Niederhuber, Jared C. Roach, Millan S. Patel  The American Journal of Human Genetics  Volume 95, Issue 3, Pages 275-284 (September 2014) DOI: 10.1016/j.ajhg.2014.07.011 Copyright © 2014 The American Society of Human Genetics Terms and Conditions

Figure 1 Clinical Vignettes for AOS Individuals from Families 1, 2, and 4 (A–C) Family 1 proband (1-II-3): scarred aplasia cutis lesion affecting the scalp at age 5 years (A), calcific deposits in the subcutaneous tissue of the distal first toe (arrow, B), and terminal transverse defect of the toes and cutis marmorata in infancy (C). (D–F) Family 2 proband (2-III-1): distal hypoplasia of the digits of the left hand (D) and toes of the feet (E) and aplasia cutis of the scalp (F). (G and H) Family 2 father of the proband (2-II-1): aplasia cutis of the scalp (G) and terminal transverse defects of both feet (H). (I–K) Family 4 proband (4-II-1): MRI of the brain on day of life (DOL) 9 shows areas of infarcts (solid arrows) and an area of partial thrombus (outlined arrow) from axial sections on diffusion weighted MRI (I and J) and axial T2-weighted MRI (K). The American Journal of Human Genetics 2014 95, 275-284DOI: (10.1016/j.ajhg.2014.07.011) Copyright © 2014 The American Society of Human Genetics Terms and Conditions

Figure 2 Pedigrees of the AOS-Affected Families and the Respective NOTCH1 Variants (A) Affected males are represented by solid squares, affected females are represented by solid circles, and index individuals are indicated by arrows. For individuals tested by WGS and/or Sanger sequencing, the genotypes are noted below in boxes; WT indicates the wild-type genotype, and the five different mutations observed in NOTCH1 (RefSeq accession number NM_017617.3) are numbered as follows: (1) the 85 kb deletion, (2) c.743−1G>T (splice site), (3) c.1285T>C (p.Cys429Arg), (4) c.4487G>A (p.Cys1496Tyr), and (5) c.5965G>A (p.Asp1989Asn). (B) For family 1, analysis of sequencing coverage is shown and indicates a 85 kb deletion (chr9: 139,439,621–139,524,478) that overlaps with the promoter region and coding sequence of NOTCH1 (chr9: 139,388,896–139,440,238) in the proband. For families 2–5, Sanger sequencing chromatograms show the respective variants (red asterisks). (C) The exon-intron structure of NOTCH1 is shown. The red triangles indicate our reported mutations in NOTCH1: (1) the 85 kb deletion, (2) c.743−1G>T (splice site), (3) c.1285T>C (p.Cys429Arg), (4) c.4487G>A (p.Cys1496Tyr), and (5) c.5965G>A (p.Asp1989Asn). Blue dots indicate previously reported NOTCH1 variants associated with isolated cardiac defects. The American Journal of Human Genetics 2014 95, 275-284DOI: (10.1016/j.ajhg.2014.07.011) Copyright © 2014 The American Society of Human Genetics Terms and Conditions

Figure 3 Modeling the Effect of the NOTCH1 Variants p.Cys429Arg, p.Cys1496Tyr, and p.Asp1989Asn on Protein Structure and Energetics For each variant, the left and middle panels show 20 energy-minimized structures from Rosetta modeling (A, D, and G represent the wild-type proteins, and B, E, and H represent the simulated substitutions). In (C), (F), and (I), the predicted change in the free energy of protein folding and stability upon substitution (ΔΔG) is shown for each variant (blue, wild-type; pink, variant protein). Higher values indicate decreased domain stability. The American Journal of Human Genetics 2014 95, 275-284DOI: (10.1016/j.ajhg.2014.07.011) Copyright © 2014 The American Society of Human Genetics Terms and Conditions