PurposeGermline WWOX pathogenic variants
have been associated with disorder of sex differentiation (DSD), spinocerebellar
ataxia (SCA), and WWOX-related epileptic
encephalopathy (WOREE syndrome). We review clinical and molecular data on
WWOX-related disorders, further
describing WOREE syndrome and phenotype/genotype correlations.MethodsWe report clinical and molecular findings in 20 additional patients
from 18 unrelated families with WOREE syndrome and biallelic pathogenic variants
in the WWOX gene. Different molecular
screening approaches were used (quantitative polymerase chain reaction/multiplex
ligation-dependent probe amplification [qPCR/MLPA], array comparative genomic
hybridization [array-CGH], Sanger sequencing, epilepsy gene panel, exome
sequencing), genome sequencing.ResultsTwo copy-number variations (CNVs) or two single-nucleotide
variations (SNVs) were found respectively in four and nine families, with
compound heterozygosity for one SNV and one CNV in five families. Eight novel
missense pathogenic variants have been described. By aggregating our patients
with all cases reported in the literature, 37 patients from 27 families with
WOREE syndrome are known. This review suggests WOREE syndrome is a very severe
epileptic encephalopathy characterized by absence of language development and
acquisition of walking, early-onset drug-resistant seizures, ophthalmological
involvement, and a high likelihood of premature death. The most severe clinical
presentation seems to be associated with null genotypes.ConclusionGermline pathogenic variants in WWOX are clearly associated with a severe early-onset epileptic
encephalopathy. We report here the largest cohort of individuals with WOREE
syndrome.