“…Of note, the recent discovery of new CHARGE syndrome candidate genes [36,37] also strongly supports the idea that dysregulation of chromatin structure-dependent cotranscriptional alternative splicing plays a fundamental role in CHARGE syndrome pathogenesis. Indeed, direct and/or indirect evidence for a regulatory role in alternative splicing exists for all new five candidate genes (PUF60, EP300, RERE, KMT2D and KDM6A): PUF60 encodes a bona fide splicing factor [38,39]; EP300 codes for the p300 histone acetyltransferase, which has been shown to be directly involved in splicing regulation [40]; RERE codes for a transcriptional co-repressor that notably associates with HDAC1/2 [41][42][43], which are included in the Fam172a/spliceosome interactomes [22,35]; KMT2D encodes a H3K4methyltransferase that is included in the spliceosome interactome [35], and trimethylation of H3K4 is known to trigger the recruitment of splicing factors [33]; and finally, KDM6A codes for a demethylase of H3K27me3, a histone mark associated with AGO-mediated splicing regulation [28]. Considering all of the above, we thus believe that a link with cotranscriptional alternative splicing would help prioritizing potentially damaging variants in CHD7 mutation-negative individuals suspected to have CHARGE syndrome or a related pathology.…”