A de novo 1.2 Mb-4q25 proximal microdeletion encompassing the genes COL25A1 and ELOVL6 has been reported once in a 20-year-old woman. She had dysmorphic features and a complex behavioral phenotype, as described in table 1 [Verhoeven et al., 2013]. Through genotype-phenotype correlation, COL25A1 and EGF were proposed as candidate genes responsible for her unique phenotype [Verhoeven et al., 2013]. Prior to that publication, 4q25 microdeletion syndrome was mostly associated with Axenfeld-Rieger syndrome, with 95% of the affected patients having mutations or deletions involving the PITX2 gene or related upstream regulatory genes, often in a haploinsufficient manner [Amendt et al., 2000;Becker et al., 2003]. Here, we report on 2 additional patients (a child and his mother) having a smaller, but overlapping deletion characterized by a common behavioral and physical phenotype. The 3 patients combined suggest the existence of a novel 4q25 proximal deletion syndrome.
Patients and Methods
Clinical Case FindingsA 29-month-old Caucasian boy presented to our clinic with his 19-year-old mother. His medical history included birth via Cesarean section for fetal distress, eczema, and seasonal allergies.
Key Words COL25A1 · Developmental delay · EGF · Hypotelorism · Hypotonia · Mandible asymmetry · Microdeletion 4q25Abstract Haploinsufficient microdeletions within chromosome 4q25 are often associated with Axenfeld-Rieger syndrome. A de novo 4q25 deletion, 675 kb proximal to PITX2 , has previously been reported once in an adult patient. The patient did not have Axenfeld-Rieger anomaly, but instead had intellectual disability and a complex behavioral phenotype with withdrawn, stereotypic, and ritualistic behavior. Array comparative genome hybridization demonstrated a smaller, overlapping 4q25 deletion in a 2-year-old patient and his mother, both having significant phenotypic overlap with the initially reported patient. All 3 patients have distinct facial features (including mild hypotelorism and subtle mandibular asymmetry), developmental delay, and complex behavioral difficulties. A genotype-phenotype correlation narrows the shared phenotype to a common COL25A1 gene aberration and proposes that the concurrent EGF gene loss has a significant impact on the phenotypic severity. Overall, our patients provide data to support the existence of a novel 4q25 proximal deletion syndrome.